[Late complications of episiotomy]

Area of Science:

• Obstetrics and Gynecology
• Surgical Outcomes
• Women's Health

Background:

• Episiotomy is a common procedure during childbirth.
• The long-term effects of different episiotomy types on maternal health are not fully understood.
• Perineal discomfort and anal incontinence are potential complications.

Purpose of the Study:

• To evaluate the long-term effects of episiotomy on perineal discomfort, wound healing, and anal incontinence.
• To compare outcomes between mediolateral episiotomy, median episiotomy, and no episiotomy.
• To provide evidence-based recommendations for episiotomy practices.

Main Methods:

• A questionnaire and phone calls were used to interview 467 women 1-5 years after delivery.
• Participants were categorized based on whether they had a mediolateral episiotomy, median episiotomy (including complete perineotomies), or no episiotomy.
• Data collected included perineal pain, dyspareunia, and anal incontinence.

Main Results:

• Dyspareunia was significantly higher in women with episiotomies compared to those without (p < 0.01).
• Perineal pain while sitting was more frequent with mediolateral episiotomy than median or no episiotomy (p < 0.05).
• Anal incontinence was significantly more common in women with episiotomies (p < 0.01), though persistent issues were rare.

Conclusions:

• Median episiotomy appears to have better outcomes than mediolateral episiotomy.
• Episiotomy should be used restrictively, with median episiotomy preferred over mediolateral when indicated.
• Adequate reconstruction of perineal tears is crucial for good healing.