PubMed Health⌕ Search

PubMed · 15631857

[Episiotomy -- routine versus selective use].

Abstract

Episiotomy is a widely used surgical procedure, introduced in the medical practice with no support of its benefit from scientific evidence. It is still used routinely despite not accomplishing the major goals for which it was pretended. In fact, it does not decrease the risk of severe perineal lacerations, it fails to prevent the development of pelvic relaxation and it does not have any impact in newborn mortality or morbidity. Many trials, retrospective and prospective, have compared general versus selective use of episiotomy. A selective use is associated with better results, such as a decrease of severe lacerations, a highest number of women in whom the perineum remains intact, despite an increase in anterior lacerations. It seems correct to recommend a selective episiotomy, and many authors suggest the use of this procedure in 30% of the cases. It is now very important to improve new birthing techniques that maintain the integrity of the perineum and do not involve surgical procedures. More trials are necessary to clarify which are the real indications to use episiotomy. Meanwhile, without the proper scientific evidence, the most correct attitude seems to be a careful use of episiotomy, with decisions on a case-by-case basis.

Explore related subjects

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

Bárbara Bettencourt Borges, Fátima Serrano, Fernanda Pereira. 2003-12-01. [Episiotomy -- routine versus selective use].. https://pubmed.ncbi.nlm.nih.gov/15631857/

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

Outcomes of routine episiotomy: a systematic review.

CONTEXT: Episiotomy at the time of vaginal birth is common. Practice patterns vary widely, as do professional opinions about maternal risks and benefits associated with routine use. OBJECTIVE: To systematically review the best evidence available about maternal outcomes of routine vs restrictive use of episiotomy. EVIDENCE ACQUISITION: We searched MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Collaboration resources and performed a hand search for English-language articles from 1950 to 2004. We included randomized controlled trials of routine episiotomy or type of episiotomy that assessed outcomes in the first 3 postpartum months, along with trials and prospective studies that assessed longer-term outcomes. Twenty-six of 986 screened articles provided relevant data. We entered data into abstraction forms and conducted a second review for accuracy. Each article was also scored for research quality. EVIDENCE SYNTHESIS: Fair to good evidence from clinical trials suggests that immediate maternal outcomes of routine episiotomy, including severity of perineal laceration, pain, and pain medication use, are not better than those with restrictive use. Evidence is insufficient to provide guidance on choice of midline vs mediolateral episiotomy. Evidence regarding long-term sequelae is fair to poor. Incontinence and pelvic floor outcomes have not been followed up into the age range in which women are most likely to have sequelae. With this caveat, relevant studies are consistent in demonstrating no benefit from episiotomy for prevention of fecal and urinary incontinence or pelvic floor relaxation. Likewise, no evidence suggests that episiotomy reduces impaired sexual function--pain with intercourse was more common among women with episiotomy. CONCLUSIONS: Evidence does not support maternal benefits traditionally ascribed to routine episiotomy. In fact, outcomes with episiotomy can be considered worse since some proportion of women who would have had lesser injury instead had a surgical incision.

Episiotomy↗

Episiotomy and vaginal trauma.

The era of routine episiotomy is gradually ending. Previously perceived benefits gradually have been disproved as evidence-based scientific clinical studies have shown the detrimental effects of episiotomy; however, circumstances always will exist in which prudent clinical judgment may dictate the necessity for an episiotomy. In most of these situations, however, an episiotomy often can be avoided. Perhaps more hospital perinatal review committees should evaluate episiotomy rates and strive to convince their staff to reduce their rates. We can learn to be more patient and allow the natural forces of labor to gradually stretch the perineum. In reviewing the extensive volume of published literature on episiotomy and perineal-vaginal trauma, the best advice lies in the dictum "Don't just do something, sit there!"

Episiotomy↗

[Instrumental extraction with Thierry's spatula: 166 cases].

OBJECTIVES: To describe the frequency of maternal and neonatal complications resulting from the use of Thierry's spatulas. MATERIALS AND METHODS: This retrospective study included 166 patients treated during a 17-month period. RESULTS: For 100% of the patients, the use of the spatulas allowed the extraction of the new born, in 68 cases (41%) the new born was engaged between one and two centimeters below the spines. A medio-lateral episiotomy was performed in 159 patients (96%). A serious perineal tear (Type 3) occurred for 6 of these patients (3.6%). A simple perineal tear (Type 1) or vaginal tear occurred in 24 (18%). Episiotomy was performed in 18 patients and was significantly protective. No case of serious neonatal complication were related to the use of the spatulas. CONCLUSION: We found that perineal tear rate is similar to that observed with other instruments used for fetal extraction. No case of fetal trauma could be related to the use of the spatulas; this was the goal of Thierry who creation the instrument. The use of Thierry's spatulas as a reference instrument is warranted, particularly for cases of prematurity, as these spatulas fulfil the modern obstetrics requirements of fetal protection, without maternal risk.

Episiotomy↗