Episiotomy

This is a cut in the perineum that enlarges the vaginal introitus. It removes the peripheral resistance of the perineum, increases the safety of many obstetric procedures and shortens the second stage of labour. However a systematic review has found no health benefits from episiotomy (see notes below).

Care should be taken to obtain consent for an episiotomy as the woman may resent what might be seen as an unnatural intervention.

Notes:

• a systematic review concerning the use of episiotomy in obstetrical care has been undertaken (1)
  • the systematic review found no health benefits from episiotomy
    • the authors found fair to good evidence suggesting that the immediate outcomes for routine (liberal-use policies) episiotomy are no better than those for indicated use of episiotomy under more restrictive-use policies
      • the authors state that routine use is harmful to the degree that it creates a surgical incision of greater extent than many women might have experienced had episiotomy not been performed
    • the harms of midline episiotomy are greater than the harms of mediolateral episiotomy
  • episiotomy repair
    • leaving the perineal skin unsutured may confer some benefit;
    • if suturing is indicated, then a continuous, subcuticular method is better than an interrupted, transcutaneous method

Reference:

1. Viswanathan M et al. The use of episiotomy in obstetrical care: a systematic review. Evid Rep Technol Assess (Summ) 2005;112:1-8.