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Episiotomy for vaginal birth.
Guillermo Carroli1, Luciano Mignini
1Centro Rosarino de Estudios Perinatales, Pueyrredon 985, Rosario, Santa Fe, Argentina, 2000. gcarroli@crep.com.ar
The Cochrane Database of Systematic Reviews
|January 23, 2009
Summary
Restrictive episiotomy use during childbirth reduces severe perineal trauma, suturing, and complications compared to routine use. However, it may increase anterior perineal trauma risk.
Area of Science:
- Obstetrics and Gynecology
- Surgical Procedures
Background:
- Routine episiotomy is common but its necessity and impact on severe perineal tears are debated.
- The comparative effects of midline versus midlateral episiotomy require further clarification.
Purpose of the Study:
- To evaluate the outcomes of a restrictive episiotomy approach versus routine episiotomy during vaginal birth.
Main Methods:
- A systematic review of randomized controlled trials was conducted.
- Eight studies involving 5541 women were included to compare restrictive versus routine episiotomy.
Main Results:
- Restrictive episiotomy significantly decreased severe perineal trauma, suturing needs, and healing complications.
- An increased risk of anterior perineal trauma was observed with restrictive episiotomy.
- No significant differences were found in severe vaginal/perineal trauma, dyspareunia, urinary incontinence, or pain measures.
Conclusions:
- Restrictive episiotomy policies offer benefits including reduced posterior perineal trauma and fewer complications.
- While generally favorable, restrictive episiotomy is associated with a higher incidence of anterior perineal trauma.
- The findings support a shift towards more selective episiotomy practices in vaginal births.
