Selective versus routine use of episiotomy for vaginal birth

Abstract

Background Some clinicians believe that routine episiotomy, a surgical cut of the vagina and perineum, will prevent serious tears during childbirth. On the other hand, an episiotomy guarantees perineal trauma and sutures. Objectives To assess the effects on mother and baby of a policy of selective episiotomy ('only if needed') compared with a policy of routine episiotomy ('part of routine management') for vaginal births. Search methods We searched Cochrane Pregnancy and Childbirth's Trials Register (14 September 2016) and reference lists of retrieved studies. Selection criteria Randomised controlled trials (RCTs) comparing selective versus routine use of episiotomy, irrespective of parity, setting or surgical type of episiotomy. We included trials where either unassisted or assisted vaginal births were intended. Quasi‐RCTs, trials using a cross‐over design or those published in abstract form only were not eligible for inclusion in this review. Data collection and analysis Two authors independently screened studies, extracted data, and assessed risk of bias. A third author mediated where there was no clear consensus. We observed good practice for data analysis and interpretation where trialists were review authors. We used fixed‐effect models unless heterogeneity precluded this, expressed results as risk ratios (RR) and 95% confidence intervals (CI), and assessed the certainty of the evidence using GRADE. Main results This updated review includes 12 studies (6177 women), 11 in women in labour for whom a vaginal birth was intended, and one in women where an assisted birth was anticipated. Two were trials each with more than 1000 women (Argentina and the UK), and the rest were smaller (from Canada, Germany, Spain, Ireland, Malaysia, Pakistan, Columbia and Saudi Arabia). Eight trials included primiparous women only, and four trials were in both primiparous and multiparous women. For risk of bias, allocation was adequately concealed and reported in nine trials; sequence generation random and adequately reported in three trials; blinding of outcomes adequate and reported in one trial, blinding of participants and personnel reported in one trial. For women where an unassisted vaginal birth was anticipated, a policy of selective episiotomy may result in 30% fewer women experiencing severe perineal/vaginal trauma (RR 0.70, 95% CI 0.52 to 0.94; 5375 women; eight RCTs; low‐certainty evidence). We do not know if there is a difference for blood loss at delivery (an average of 27 mL less with selective episiotomy, 95% CI from 75 mL less to 20 mL more; two trials, 336 women, very low‐certainty evidence). Both selective and routine episiotomy have little or no effect on infants with Apgar score less than seven at five minutes (four trials, no events; 3908 women, moderate‐certain...

How did episiotomy rates change from 2007 to 2014? Population-based study in France

“…These results were consistent with those of the Euro-peristat project, which described an increase in the rate of severe perineal tears for all vaginal deliveries between 2004 and 2010 in all European countries, except Germany and Norway [28]. This issue is still the subject of a controversial debate [7, 9, 20, 29–32]. Randomized trials showed no increase in severe perineal tears related to the restrictive use of episiotomy [3].…”

The quality of sexual life after experiencing the episiotomy birth

“…The recommended use is restrictive (only in the case of indications such as foetal distress and the urgent need to finish the labour quickly) (Jiang et al, 2017). In case of the need for episiotomy, the correct timing to perform the procedure is when 3-4 cm of presenting part of the baby is visible in between the contractions.…”

“…Episiotomy also weakens perineal muscles (Walsh, 2007) and can predispose woman to perineal trauma, therefore routines use is not advised (Jiang et al, 2017).…”

Zdravje delovno aktivne populacije / Health of the Working-Age Population

“…Episiotomy The recommended use is restrictive (only in the case of indications such as foetal distress and the urgent need to finish the labour quickly) (Jiang et al, 2017). In case of the need for episiotomy, the correct timing to perform the procedure is when 3-4 cm of presenting part of the baby is visible in between the contractions.…”