Different episiotomy techniques, postpartum perineal pain, and blood loss: an observational study

The lateral episiotomy technique has been postulated to cause more postpartum perineal pain and blood loss compared to the midline and mediolateral episiotomy technique. The aim of the study was to explore the association with postpartum perineal pain and blood loss between different episiotomy techniques.

Clinical evaluation of episiotomy was performed 0-3 days after delivery on 300 participating women. Episiotomy technique was classified by millimeter distance from the incision point to the posterior fourchette and by angle from the sagittal plane in degrees. Postpartum perineal pain was scored on a visual analogue scale (VAS) the first day after delivery. Blood loss data were collected from medical charts. Different episiotomy techniques and different episiotomy incision point groups were compared in relation to perineal pain perception and blood loss.

We found no difference between midline, mediolateral, and lateral episiotomy techniques in perineal pain perception the first postpartum day (p = 0.74) or in estimated blood loss (p = 0.38). No differences were found in perineal pain or blood loss between midline and lateral incision points. Mediolateral angles were significantly narrower than lateral angles (p < 0.005). Physicians performed longer episiotomies than midwives (p < 0.005), but episiotomy angle did not vary between professions (p = 0.075).

No differences in perineal pain perception the first postpartum day and no differences in estimated blood loss were found when comparing different episiotomy techniques or when comparing midline and lateral incision points.