Inpatient postpartum recovery following episiotomy: secondary outcomes of a prospective observational study

Data regarding the effect of episiotomy on postpartum recovery is limited. This study aimed to examine the impact of episiotomy on quality of inpatient postpartum recovery following spontaneous and operative vaginal delivery.

We performed a secondary analysis on a prospective cohort study on women with term deliveries of healthy neonates who completed a survey within 24-48 h postpartum. The survey included maternal, obstetric, and demographic data, and the validated postpartum recovery tool (ObsQoR-10-Heb). The primary outcome was postpartum recovery scores from the ObsQoR tool following spontaneous vaginal delivery (SVD) with and without episiotomy (mean ± standard deviation). Secondary outcomes included postpartum recovery scores after operative vaginal delivery (OVD) with and without episiotomy, and comparisons to elective and emergency cesarean delivery (CD). Additionally, we sought to identify specific ObsQoR items contributing to poor recovery among patients following episiotomy.

Data on 325 women were available for analysis. The ranked order of postpartum recovery scores was SVD without episiotomy (80.58 ± 12.15), OVD without episiotomy (72.22 ± 19.41), SVD with episiotomy (69.38 ± 13.59), elective CD (68.61 ± 16.28), OVD with episiotomy (68.00 ± 15.57), and emergency CD (55.63 ± 16.89), reflecting the poorest recovery. Mean difference in score among women undergoing SVD with and without episiotomy was -11.2 (95% CI -18.4 to -4.0; P < 0.001). Mean difference in scores following OVD with and without episiotomy was -4.2 (95% CI -19.7 to 11.2; P = 0.970). Among recovery items, pain and discomfort ranked lowest for all delivery modes, contributing most to the reduced recovery score.

Episiotomy negatively impacts inpatient postpartum recovery after SVD. Pain and maternal discomfort are key factors adversely affecting recovery across all delivery modes.