Pregnancy Outcomes of Healthy Parturients Delivered With or Without Episiotomy

The use of episiotomy, a previously popular obstetric procedure, has been declining for the last 25 years, falling from 65% of deliveries in 1979 to 18% in 2003. Some complications have been reported in terms of maternal side effects; however, many episiotomies are still performed in Rajavithi Hospital.

To compare maternal and neonatal outcomes and complications in the 48-hour period after vaginal delivery in healthy parturients with and without episiotomy.

A historical cohort study was conducted by reviewing the medical records of 920 healthy parturients who gave birth vaginally in Rajavithi Hospital between January 1st and December 31st 2012. Data were collected of 460 cases who delivered with episiotomy and another 460 vaginal-delivery patients who did not. Data collection included maternal characteristics, and maternal and neonatal outcomes.

Most parturients were parous cases (711/920, 77.3%). Gestational age, number of nulliparae, and duration of 2nd stage of labor were significantly higher in the episiotomy group. Third and fourth degree perineal tear was significantly higher in the episiotomy group than in the non-episiotomy group (21.0%: 0.0% and 20.2%: 0.0%; p<0.001) in nulliparous women, but there was no difference inparous patients. Wound infection within 48 hours postpartum was similar in parous parturients in the episiotomy and non-episiotomy groups while there was no wound infection in the nulliparous group. Mean birthweight in the episiotomy group was significantly higher than in the non-episiotomy groups (3,064.95±418.44 gm vs. 2,940.15±486.61 gm; p<0.001). Other neonatal outcomes and complications were similar in the two groups.

Incidence of second, third and fourth degree perineal tear was significantly higher in the episiotomy group than in the non-episiotomy group.