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[Episiotomy -- routine versus selective use].

Bárbara Bettencourt Borges1, Fátima Serrano, Fernanda Pereira

  • 1Serviço de Ginecologia e Obstetrícia, Maternidade Dr Alfredo da Costa, Lisboa.

Acta Medica Portuguesa
|January 6, 2005
PubMed
Summary
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Episiotomy, a surgical procedure, lacks scientific evidence of benefit and does not prevent severe perineal lacerations or improve newborn outcomes. Selective use shows better results, but more research is needed for clear indications.

Area of Science:

  • Obstetrics and Gynecology
  • Surgical Procedures
  • Evidence-Based Medicine

Background:

  • Episiotomy is a common surgical intervention during childbirth.
  • Its routine use is not supported by robust scientific evidence regarding benefits.
  • The procedure was intended to prevent severe perineal lacerations and pelvic relaxation, and impact newborn outcomes.

Purpose of the Study:

  • To evaluate the effectiveness of episiotomy in childbirth.
  • To compare the outcomes of routine versus selective episiotomy.
  • To assess the impact of episiotomy on maternal and newborn health.

Main Methods:

  • Review of numerous prospective and retrospective trials comparing general versus selective episiotomy.
  • Analysis of data on perineal lacerations, pelvic relaxation, and newborn mortality/morbidity.

Related Experiment Videos

  • Examination of current medical practices and recommendations regarding episiotomy.

    • Main Results:

    • Episiotomy does not decrease the risk of severe perineal lacerations.
    • It fails to prevent pelvic relaxation and has no impact on newborn mortality or morbidity.
    • Selective episiotomy is associated with a decrease in severe lacerations and an increase in intact perinea, despite more anterior lacerations.

    Conclusions:

    • Selective episiotomy, potentially in 30% of cases, is associated with better outcomes than routine use.
    • There is a need for improved birthing techniques that preserve perineal integrity without surgical intervention.
    • Further trials are required to establish clear indications for episiotomy, advocating for careful, case-by-case application in the interim.