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[Late complications of episiotomy]
J C Rageth1, A Buerklen, H A Hirsch
1Universitätsfrauenklinik, Schleichstr. 4, D-7400 Tübingen.
By means of a questionnaire and partly by phone calls 467 women who delivered at the Universitäts-Frauenklinik Tübingen 1-5 years ago were interviewed regarding perineal discomfort, wound healing and anal incontinence. 106 women have had a mediolateral episiotomy, 250 a median episiotomy (including 115 complete perineotomies) and 111 women have had no episiotomy. Dyspareunia was reported in 47% of the primiparous woman and by 22% of multiparous women with episiotomy; by contrast without episiotomy, this problem occurred only in 7% and 8% of primiparous and multiparous patients respectively (p less than 0.01). Perineal pain while sitting on a chair was reported by 30% of women with mediolateral episiotomy as compared to 19% of those with median episiotomy or complete perineotomy and 4.5% without episiotomy (median episiotomy vs. mediolateral episiotomy: p less than 0.05, episiotomy vs. no episiotomy: p less than 0.001). Occasional involuntary passage of flatus occurred in 18%, 22% and 14% respectively (differences not significant); involuntary passage of faeces in 7%, 9% and 1% respectively (episiotomy vs. no episiotomy: p less than 0.01). The occasional involuntary passage of faeces persisted for more than 6 months in 2 of 106 women with mediolateral episiotomy and in 3 of 250 women with median episiotomy. Because of the good healing of adequately reconstructed perineal tears and the better outcome of median episiotomy as compared to mediolateral episiotomy the authors advocate to use episiotomy restrictively and, if enlargement of the vaginal outlet is indicated, to use median rather than mediolateral episiotomy. If necessary, median episiotomy may be extended to complete perineotomy.
By means of a questionnaire and partly by phone calls 467 women who delivered at the Universitäts-Frauenklinik Tübingen 1-5 years ago were interviewed regarding perineal discomfort, wound healing and anal incontinence. 106 women have had a mediolateral episiotomy, 250 a median episiotomy (including 115 complete perineotomies) and 111 women have had no episiotomy. Dyspareunia was reported in 47% of the primiparous woman and by 22% of multiparous women with episiotomy; by contrast without episiotomy, this problem occurred only in 7% and 8% of primiparous and multiparous patients respectively (p less than 0.01). Perineal pain while sitting on a chair was reported by 30% of women with mediolateral episiotomy as compared to 19% of those with median episiotomy or complete perineotomy and 4.5% without episiotomy (median episiotomy vs. mediolateral episiotomy: p less than 0.05, episiotomy vs. no episiotomy: p less than 0.001). Occasional involuntary passage of flatus occurred in 18%, 22% and 14% respectively (differences not significant); involuntary passage of faeces in 7%, 9% and 1% respectively (episiotomy vs. no episiotomy: p less than 0.01). The occasional involuntary passage of faeces persisted for more than 6 months in 2 of 106 women with mediolateral episiotomy and in 3 of 250 women with median episiotomy. Because of the good healing of adequately reconstructed perineal tears and the better outcome of median episiotomy as compared to mediolateral episiotomy the authors advocate to use episiotomy restrictively and, if enlargement of the vaginal outlet is indicated, to use median rather than mediolateral episiotomy. If necessary, median episiotomy may be extended to complete perineotomy.