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At least 19 recordsLinked to original sources
PubMed2001

The effect of epidural analgesia on rates of episiotomy use and episiotomy extension in an inner-city hospital.

OBJECTIVE: To determine the relationship between epidural analgesia and episiotomy usage and episiotomy extension in parturients delivering vaginally. METHODS: A database of 20 888 women experiencing spontaneous vaginal delivery at Grady Memorial Hospital from 1990 to 1995 was examined to identify those receiving epidural analgesia. Patients who underwent epidural catheter placement and had adequate perineal anesthesia at delivery comprised the epidural group, and all others comprised the control group. Demographic characteristics and obstetric outcomes were compared. Univariate and multivariate analyses were used to test the association between epidural analgesia, rates of episiotomy and episiotomy extension. RESULTS: Of the 20888 women experiencing spontaneous vaginal deliveries 6785 (32.5%) received epidural analgesia. Women receiving epidural analgesia were more likely than those not receiving epidural analgesia to be African-American and nulliparous, and to have an occiput posterior presentation. Women receiving epidural analgesia were also more likely to receive an episiotomy (27.8% vs. 13.1%, odds ratio (OR) 2.56, 95% confidence interval (CI) 2.38-2.75) and were less likely to experience a second-degree perineal laceration (11.6% vs. 14.4%, OR 0.75, 95% CI 0.69-0.82) or a third- or fourth-degree extension (8.9% vs. 12.4%, OR 0.81, 95% CI 0.68-0.97). When the results were adjusted for nulliparity, posterior presentation, macrosomia, shoulder dystocia and prolonged second stage, epidural analgesia remained independently associated with receipt of episiotomy (OR 1.97, 95% CI 1.88-2.06) and reduced episiotomy extension (OR 0.74, 95% CI 0.54-0.94). CONCLUSION: Epidural analgesia increases the rates of episiotomy use, and decreases the rate of episiotomy extension, independently of clinical factors associated with episiotomy.

Adult↗
PubMed2006

[Liberal versus restrictive practice of episiotomy: do there exist specific obstetrical indications for episiotomy?].

PURPOSE: To analyze the literature comparing two different policies for episotomy practice: liberal versus restrictive use. To search and discuss specific indications for episiotomy. METHODS: The Medline base was analyzed from 1970 to 2005. The articles where selected by using the key word episiotomy and selective or restrictive and routine or liberal. Every potential indications was crossed with episotomy. RESULTS: A policy implying a liberal practice of episiotomy is not better compared to a restrictive policy. The evidence-based medical literature favors avoiding routine episiotomy in low risk deliveries. Data are quite scarce concerning the different specific indications for episiotomy, and finally we can retain only one specific indication which is the short perineum when the distance between the fourchette and the center of the anus is less than 3 cm. Nevertheless, in order to improve delivery conditions obstetricians can advisably use episiotomy in accordance with their clinical assessment. CONCLUSION: There is no evidence in the literature favoring a liberal policy over a restrictive policy for the use of episiotomy, both in terms of fetal (Grade C) and maternal (Grade A) indications. A number of obstetrical situations considered as at risk do not systematically indicate an episiotomy. There are however circumstances in which a pertinent and prudent clinical assessment will lead the obstetrician to use an episiotomy.

Adult↗
PubMed2002

Has the use of routine episiotomy decreased? Examination of episiotomy rates from 1983 to 2000.

OBJECTIVE: To determine if practice patterns have been altered by the large body of literature strongly advocating the selective use of episiotomy. METHODS: An electronic audit of the medical procedures database at Thomas Jefferson University Hospital from 1983 to 2000 was completed. Univariate and multivariable models were computed using logistic regression models. RESULTS: Overall episiotomy rates in 34,048 vaginal births showed a significant reduction from 69.6% in 1983 to 19.4% in 2000. Significantly decreased risk of episiotomy was seen based upon year of childbirth (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.86, 0.87), black race (OR 0.29, 95% CI 0.28, 0.31), and spontaneous vaginal delivery (OR 0.40, 95% CI 0.36, 0.45). Increased association with episiotomy was seen in forceps deliveries (OR 4.04, 95% CI 3.46, 4.72), and with third- or fourth-degree lacerations (OR 4.87, 95% CI 4.38, 5.41). In deliveries with known insurance status, having Medicaid insurance was also associated with a decreased episiotomy risk (OR 0.59, 95% CI 0.54, 0.64). CONCLUSION: There was a statistically significant reduction in the overall episiotomy rate between 1983 and 2000. White women consistently underwent episiotomy more frequently than black women even when controlling for age, parity, insurance status, and operative vaginal delivery.

Adult↗
PubMedDate not supplied

Routine vs selective episiotomy: a randomised controlled trial. Argentine Episiotomy Trial Collaborative Group.

Episiotomy is a widely-done intervention in childbirth, regardless of poor scientific evidence of its benefits. This randomised controlled trial compares selective with routine use of a mediolateral episiotomy for women having first and second deliveries in 8 public maternity units in Argentina. 2606 women participated; 1555 were nulliparous (778 in the selective group and 777 in the routine group) and 1051 primiparous (520 in the selective group and 531 in the routine group). The two interventions compared were selective (limited to specified maternal or fetal indications), and routine episiotomy (following the hospital's previous policy). Episiotomy was done in 30.1% of deliveries in the selective, and 82.6% in the routine group. The main outcome measure was severe perineal trauma. Severe perineal trauma was uncommon in both groups but was slightly less frequent in the selective group (1.2% vs 1.5%). Anterior perineal trauma was more common in the selective group but posterior perineal surgical repair, perineal pain, healing complications, and dehiscence were all less frequent in the selective group. Routine episiotomy should be abandoned and episiotomy rates above 30% cannot be justified.

Argentina↗
PubMed1993

[Who invented the episiotomy? On the history of the episiotomy].

The most frequent operation in obstetrics is to cut ans suture an episiotomy. This technique was first mentioned in 18th century. Yet is took 100 years to be commonly accepted after it was first publicated 1810 in a medical journal. This paper will show the historical development of an episiotomy that nowadays still is a topic contrary discussion.

Episiotomy↗
PubMed2000

Episiotomy for vaginal birth.

BACKGROUND: Episiotomy is done to prevent severe perineal tears, but its routine use has been questioned. The relative effects of midline compared with midlateral episiotomy are unclear. OBJECTIVES: The objective of this review was to assess the effects of restrictive use of episiotomy compared with routine episiotomy during vaginal birth. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised trials comparing restrictive use of episiotomy with routine use of episiotomy; restrictive use of mediolateral episiotomy versus routine mediolateral episiotomy; restrictive use of midline episiotomy versus routine midline episiotomy; and use of midline episiotomy versus mediolateral episiotomy. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by two reviewers. MAIN RESULTS: Six studies were included. In the routine episiotomy group, 72.7% (1752/2409) of women had episiotomies, while the rate in the restrictive episiotomy group was 27.6% (673/2441). Compared with routine use, restrictive episiotomy involved less posterior perineal trauma (relative risk 0. 88, 95% confidence interval 0.84 to 0.92), less suturing (relative risk 0.74, 95% confidence interval 0.71 to 0.77) and fewer healing complications (relative risk 0.69, 95% confidence interval 0.56 to 0.85). Restrictive episiotomy was associated with more anterior perineal trauma (relative risk 1.79, 95% 1.55 to 2.07). There was no difference in severe vaginal or perineal trauma (relative risk 1.11, 95% confidence interval 0.83 to 1.50); dyspareunia (relative risk 1.02, 95% confidence interval 0.90 to 1.16); urinary incontinence (relative risk 0.98, 95% confidence interval 0.79 to 1.20) or several pain measures. Results for restrictive versus routine mediolateral versus midline episiotomy were similar to the overall comparison. REVIEWER'S CONCLUSIONS: Restrictive episiotomy policies appear to have a number of benefits compared to routine episiotomy policies. There is less posterior perineal trauma, less suturing and fewer complications, no difference for most pain measures and severe vaginal or perineal trauma, but there was an increased risk of anterior perineal trauma with restrictive episiotomy.

Episiotomy↗
PubMedDate not supplied

[Late complications of episiotomy].

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.

Adult↗
PubMed2003

Management of the perineum during forceps delivery. Association of episiotomy with the frequency and severity of perineal trauma in women undergoing forceps delivery.

OBJECTIVE: To examine the association of the frequency and severity of perineal trauma with episiotomy performed at forceps delivery. STUDY DESIGN: This retrospective study analyzed all forceps deliveries at the Semmelweis Women's Hospital Vienna between February 1999 and July 1999. Evaluation of a possible association of episiotomy with the frequency and severity of perineal trauma was the main objective of the study. Episiotomy was not performed routinely and was either midline or mediolateral. RESULTS: In conjunction with forceps delivery episiotomy, 76/87 women (87%) underwent forceps delivery episiotomy; among those, 49/76 (64%) had a mediolateral episiotomy and 27/76 (36%) a midline episiotomy. The frequency and severity of perineal tears were significantly lower in forceps deliveries when an episiotomy was performed. When analyzing the type of episiotomy, the data revealed a statistically significantly lower frequency of perineal trauma when mediolateral episiotomy was performed as compared to midline episiotomy. CONCLUSION: If obstetric indications necessitate forceps delivery, performance of an episiotomy decreases the risk of perineal tears of all degrees. When analyzing the type of episiotomy, mediolateral episiotomy seems to be more protective against perineal trauma in women undergoing forceps delivery.

Adult↗
PubMed2004

Episiotomy versus fetal manipulation in managing severe shoulder dystocia: a comparison of outcomes.

OBJECTIVE: In severe shoulder dystocia, when initial maneuvers fail, either episiotomy or fetal manipulation (Rubin, Woods' screw, or posterior arm release) is recommended. We sought to compare maternal and neonatal outcomes between severe shoulder dystocia deliveries managed with episiotomy versus fetal manipulation. STUDY DESIGN: We identified severe shoulder dystocia deliveries from three databases: all shoulder dystocia deliveries (1993-2003 and 1994-1997) from two teaching institutions and litigated cases of shoulder dystocia-associated permanent brachial plexus palsy from multiple U.S. institutions. Pair-wise comparisons were made among three groups of deliveries: those managed by fetal manipulation without episiotomy (fetal manipulation-only), those managed by episiotomy without fetal manipulation (episiotomy-only), and those managed with both (episiotomy + fetal manipulation). Rates of brachial plexus palsy, neonatal depression, and anal sphincter trauma were compared among groups using chi 2 , with significance at P < .05. RESULTS: Among episiotomy-only, 13 of 22 (59.1%) sustained brachial plexus palsy, compared with 20 of 57 (35.1%) among fetal manipulation-only (P = .05). Twenty-eight of 48 (58.3%) in episiotomy + fetal manipulation had brachial plexus palsy, which did not differ from episiotomy-only (P = .95) but was higher than fetal manipulation-only (P = .02), suggesting that the addition of episiotomy conferred no benefit in averting neonatal injury. Anal sphincter trauma was significantly more common among episiotomy-only and episiotomy + fetal manipulation, compared with fetal manipulation-only. CONCLUSION: In severe shoulder dystocia, if fetal manipulation can be performed without episiotomy, severe perineal trauma can be averted without incurring greater risk of brachial plexus palsy.

Adult↗
PubMed2002

Episiotomy use in the United States, 1979-1997.

OBJECTIVE: To describe episiotomy usage at vaginal delivery in the United States from 1979-1997. METHODS: We used the National Hospital Discharge Survey, a federal database of a national sample of inpatient hospitals. Data from 1979 to 1997 were analyzed using International Classification of Diseases, Ninth Revision, Clinical Modification codes for diagnoses and procedures. Rates per 1000 women were calculated using the 1990 census population for women aged 15-44 years. We calculated the number of episiotomies per 100 vaginal deliveries. Rates and percentages were compared using the score test for linear trend. RESULTS: The number of episiotomies ranged from a high of 2,015,000 in 1981 to a low of 1,128,000 in 1997. The age-adjusted annual rate for episiotomy with vaginal deliveries varied from 32.7 in 1979 to 18.7 in 1997 per 1000 women aged 15-44 years. The percentage of episiotomy with vaginal deliveries ranged from 65.3% in 1979 to 38.6% in 1997 (P <.001). Episiotomy with operative deliveries decreased over time (87.0% to 70.8%, P <.001), as did episiotomy with spontaneous deliveries (60.1% to 32.8%, P <.001). Women undergoing episiotomy were slightly younger (mean +/- standard deviation, 25.7 +/- 5.5 years) than women without episiotomy (26.2 +/- 5.7 years, P <.001). Black women (39%) were less likely to receive episiotomy than white women (60%, P <.001). More women with private insurance (62%) had episiotomy performed than women with government insurance (43%, P <.001). CONCLUSION: Although episiotomy use has decreased over time, the most recent rate of 39 per 100 vaginal deliveries remains higher than evidence-based recommendations for optimal patient care.

Adolescent↗
PubMed2003

[Effectiveness of liberal vs. conservative episiotomy in vaginal delivery with reference to preventing urinary and fecal incontinence: a systematic review].

Episiotomy is the most common surgical intervention in the world. In Europe the rate of episiotomy is approximately 30% (23). Reasons for this intervention are the reduction of risk for tears and incontinence. To assess the effects of restricted episiotomy in the prevention of urinary and faecal incontinence. Medline search for 1990-7/2002, Cochrane Library (Issue 2, 2002), GEROLIT and SOMED and the Internet. RCTs analysing restrictive or non-restrictive episiotomy were included if they had comprehensive randomisation, follow-up and exclusion of selection bias. Cohort studies were assessed to evaluate the risk of developing faecal incontinence. If possible, data were pooled. Included were all pregnant women with vaginal delivery. Intervention/exposition: Restrictive vs. liberal episiotomy (median, lateral or mediolateral). Incontinence rate (urine and stool) 3 months and 3 years post partum. All included randomised controlled studies met the criteria above, one randomised controlled study used blinded assessment of outcome parameter. Lots of follow-up was 33% (after 3 years). Cohort studies partly were retrospective. 2 randomised controlled studies measuring urinary incontinence were included. The rate for episiotomy was 60% in the intervention group with liberal episiotomy and 27% in the restricted group. No difference could be found in groups measuring urinary incontinence (RR 0.98, 95% CI 0.83-1.20). Only two included cohort studies measured the effect of episiotomy on faecal incontinence. The chance of developing faecal incontinence in association with episiotomy was more than threefold (OR = 3.64, 95% CI 2.15-6.14). Restrictive episiotomy neither effects the development of urinary incontinence of post partum women (RR 0.98 95%, CI 0.83-1.20) three months and three years after vaginal delivery, nor the risk for trauma. Women without episiotomy suffer significantly less from faecal incontinence (OR = 3.6). Further investigation is required to measure the effect of no intervention versus liberal episiotomy.

Episiotomy↗
PubMed1983

[Complaints caused by episiotomy. Study of 413 women with spontaneous complication-free labor].

In 413 women following normal spontaneous delivery the short and long term complaints due to the episiotomy were studied. Every fifth woman found the cutting of the episiotomy painful. Episiotomies done by specialist's or chief residents were found to be less-painful. The suturing of the episiotomy was found to be painful by 4 of 10 women. The more experienced the surgeon the less was the pain. Only every tenth woman had no pain in the episiotomy immediately post-partum independent of the experience of the obstetrician. Medilateral episiotoma were twice as often very painful (21%) as median episiotomies (11%). Every fifth woman had pain in the perineum for more than one month. A third of these women had more pain with sexual intercourse than prior to delivery. Every tenth woman had infections in the episiotomy, half of these required treatment. Following medio-lateral episiotomy there were twice as many complication with the episiotomy than following median-episiotomy. Every fifth woman though that her vagina and perineum was disfigured by the episiotomy scar. This impression was independent of the type of episiotomy and of the experience of the obstetrician. More dyspareunia than prior to delivery was reported by twice as many primipara (20%) as multipara (11%). 18% of the women reported that the vaginal introitus appeared to be narrower than prior to the delivery.

Dyspareunia↗
PubMed1998

Episiotomy and perineal tears in low-risk UK primigravidae.

BACKGROUND: The aim of the study was to determine the rates and to describe the risk factors for episiotomy and perineal tears in low-risk primigravidae. METHOD: A cross-sectional survey of 101 randomly selected NHS hospitals in the UK was carried out between February 1993 and January 1994. Subjects were 40 consecutive low-risk primigravidae in each hospital. The main outcome measures were number and reasons for episiotomy, and number and degree of perineal tears. RESULTS: A large proportion of women (83 per cent) experienced some form of perineal trauma. Forty per cent of the women had an episiotomy only, 6 per cent an episiotomy and perineal tear, and 37 per cent perineal or other tears without episiotomy. The main reasons for performing an episiotomy were foetal distress (27 per cent), impending tear (25 per cent) and delay of the second stage of labour (21 per cent). Fifty-nine per cent of women with a delayed second stage had a spontaneous vaginal delivery and 41 per cent required instrumental assistance. The likelihood of having an episiotomy increased with the duration of the second stage of labour, irrespective of type of delivery. Episiotomy rates varied appreciably throughout regions and hospitals in the United Kingdom, ranging from 26 to 67 per cent. There was also a large regional variation in the rates of perineal trauma; generally, high rates of one outcome were associated with low rates of the other. Compared with white women, women from the Indian sub-continent were almost twice as likely and those from the Orient almost five times as likely to have an episiotomy. CONCLUSIONS: The magnitude of the geographical variation suggests a lack of uniformity in indications for performing episiotomies and that guidelines for performing episiotomies may need to be reviewed. The rates of episiotomy in women from the Indian sub-continent and Orient were very high compared with those for white women, and this requires clarification and explanation, as they are contrary to rates experienced in these ethnic groups in other countries.

Adult↗
PubMed2002

Episiotomies in Nigeria--should their use be restricted?

Episiotomy continues to be a frequently used procedure in obstetrics despite little scientific support for its routine use. The incidence of episiotomy and perineal tears and also the indications for episiotomy were therefore investigated in 1007 singleton deliveries between January 1, 1997 and December 31, 1997 at the Lagos University Teaching Hospital. The incidence of episiotomy was 54.9% of all deliveries. Episiotomy was more frequently performed in primipara (90.4%). Perineal tears occurred in only 18.8% of all deliveries, with majority in the multipara (93.6%). Most of the team were of first degree (98.4%). No third degree tear was recorded. The commonest indication for episiotomy was that of protecting the perineum from possible tears (80.7%). All the episiotomies were mediolateral. Episiotomy rate was higher among deliveries conducted by doctors. Performance of episiotomy had a positive correlation with increasing foetal weight. No major complication or maternal death attributable to episiotomy was recorded. The results of our study suggest that the use of episiotomy can be restricted to specified indications like instrumental and big babies delivery. It is also useful for the prevention of maternal morbidity through perineal laceration. Randomized control trials will however be necessary to clarify the controversies relating to restrictive episiotomy.

Birth Weight↗