PubMed · 1138210
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J de Graaff. 1975-07-05. [Episiotomy].. https://pubmed.ncbi.nlm.nih.gov/1138210/
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OBJECTIVE: Our purpose was to examine the association between maternal vaginal and perineal morbidity and episiotomy performed at spontaneous vaginal delivery. STUDY DESIGN: We obtained data from 17,483 consecutive spontaneous vaginal deliveries and compared the yearly rates of episiotomy, lacerations, and potential confounders with linear regression and stratified analyses. RESULTS: Between 1976 and 1994 the use of episiotomy fell significantly (86.8% to 10.4%, R2 = 0.92, p = 0.0001). This change was associated with a fall in the rate of third- and fourth-degree lacerations (9.0% to 4.2%, R2 = 0.59, p = 0.0001) and a rise in the rate of intact perinea (10.3% to 26.5%, R2 = 0.68, p = 0.0001) and vaginal lacerations (5.4% to 19.3%, R2 = 0.77, p = 0.0001). These associations held in separate analyses stratified by parity and birth weight, except for the subgroup of nulliparous women with macrosomic infants. CONCLUSION: At our institution a large reduction in the use of episiotomy in spontaneous vaginal deliveries was associated with a significant reduction in perineal trauma in all groups of women except for nulliparous women with macrosomic infants.
OBJECTIVE: to review the key literature on perineal trauma, discussing the historical background, the materials and techniques used, the possible consequences of repair and assess midwives' current and potential contribution to perineal repair. LITERATURE SEARCH: the literature was identified using conventional search techniques: Midwifery Information Resource Service (MIDIRS) and the Cochrane Pregnancy and Childbirth Database. Keywords used during the search were: episiotomy, perineal trauma and adverse effects. Associated keywords words were sexuality, pain and psychology. KEY CONCLUSIONS: current practice in the UK is inconsistent with the available evidence, perineal trauma can cause long term problems, and midwives are in an ideal position to take forward evidence-based perineal repair. IMPLICATIONS FOR PRACTICE: midwives need adequate education and training in perineal repair but are likely to be more effective in performing the repair. Systematic evaluation of the impact of extending midwives' influence in this area is essential.