Episiotomy
- Definition. A surgical incision made in the perineum to facilitate delivery.
- Incidence. It used to be performed in >30% of vaginal deliveries, most often in nulliparous women, but there was a steep decline to <10% by 2006. It remains highly dependent on practice style and provider preference.
- Indications. It may be performed in isolation or in preparation for surgical vaginal delivery. It may also be used to facilitate delivery complicated by shoulder dystocia (see Chapter 63).
- Goal. Episiotomy was introduced to reduce complications of pelvic floor trauma at delivery, including bleeding, infection, genital prolapse, and incontinence. However, there does not appear to be any benefit to the mother of elective episiotomy.
- Types/extensions (Figure 66.1):
1 Midline episiotomy refers to a vertical midline incision from the posterior forchette toward the rectum. It is effective in hastening delivery, but is associated with increased severe perineal trauma involving the external anal sphincter (third and fourth degree extensions). Used more commonly in the USA.
2 Mediolateral episiotomy is cut at 45° to the posterior forchette on one side. Such incisions appear to protect against severe perineal trauma, but have been associated with increased blood loss, wound infection, and worsened postpartum pain (none of which has been definitively demonstrated). Used more commonly in the UK.
- Episiotomy repair. Primary approximation affords the best opportunity for functional repair, especially if there is rectal involvement. The external anal sphincter should be repaired by securing the cut ends using interrupted sutures.
Assisted vaginal delivery
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
