[Episiotomy--an appeal for a more restricted use]

Episiotomy is one of the most widely performed surgical procedures, and episiotomy rates of 50-90% are common. The major presumed benefit of episiotomy is prevention of perineal lacerations, especially rupture of the anal sphincter. Prevention of damage to the pelvic floor, and the relief of harmful pressure on head of the foetus, have also been suggested. There is very little evidence to support these assumptions. On the contrary, the results of three randomized studies suggest that high rates of episiotomy are associated with increased risk of sphincter rupture. These and other studies are described. In view of the long term morbidity of sphincter rupture, a more selective use of episiotomy is recommended. A rate of 20-30% seems appropriate. Indications for episiotomy are discussed. These should include delivery by forceps, and perhaps delivery by ventouse. In other cases the use of episiotomy should be restricted.