Episiotomy is a planned incision of the perineum designed to facilitate delivery of the infant. Although routine episiotomy is not generally considered indicated, a variety of conditions may require episiotomy. Such conditions include shoulder dystocia, assisted delivery, or an anticipated macrosomic infant. Studies concerning the use of episiotomies to reduce the likelihood of laceration extension to third or fourth degree have shown conflicting results. The roles of episiotomies under the conditions just described, however, have generally been recognized to assist with delivery of the infant.

Either with or without a planned episiotomy, delivery of an infant may result in laceration of the vagina, perineum, or rectum. Lacerations may involve the vagina, perineum, cervix, or uterus, as well as the vestibular tissue. Careful inspection of each of these areas should occur when postpartum hemorrhage persists beyond the expected interval. Perineal lacerations are graded (first to fourth degree) based on the degree of tissue involvement and the repair varies by laceration type. Generally, an episiotomy is equivalent to a second-degree laceration, but clinical conditions may require a more extensive episiotomy or secondary extension of the episiotomy may increase the degree of involvement. Repair of lacerations and episiotomies are generally similar and are summarized in Table 28.1.