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10.12.2019 | Maternal-Fetal Medicine

Selective use of episiotomy: what is the impact on perineal trauma? Results from a retrospective cohort study

verfasst von: Massimo Franchi, Francesca Parissone, Cecilia Lazzari, Simone Garzon, Antonio Simone Laganà, Ricciarda Raffaelli, Antonella Cromi, Fabio Ghezzi

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 2/2020

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Abstract

Purpose

To evaluate the effects of selective use of episiotomy on perineal trauma.

Methods

We performed a retrospective cohort study on consecutive vaginal deliveries from January 2010 to December 2016. From January 2010 to December 2011 episiotomy was performed liberally, based only on individual midwife/doctor’s decision. Since January 2012, a shared selective use of episiotomy policy has been introduced. To evaluate the range of perineal trauma in spontaneous second-degree perineal tears, a sub-classification of second-degree lacerations has been introduced dividing them into two sub-groups: A (smaller than the average episiotomy) and B (spontaneous vaginal tear larger than the average episiotomy). The primary outcomes were the incidence and type of perineal trauma, with the proportion of type A and type B second-degree spontaneous tears under a policy of selective episiotomy.

Results

Deliveries not exposed to selective use of episiotomy were 1583 (Group 1), those exposed to selective use of episiotomy were 6409 (Group 2). In Group 2 episiotomy rate decreased, and incidence of intact perineum, first- and second-degree lacerations increased. The incidence of third- and fourth-degree lacerations did not change. Spontaneous second-degree lacerations occurred in 19.4% and 36.8% of women in group 1 and 2, respectively. With a selective episiotomy policy, 88.3% of second-degree tears was classified as type A.

Conclusions

The selective use of episiotomy is clinically feasible and effective. This policy seems to be associated with a lower delivery-related perineal trauma as showed by the sub-classification, that could be a useful tool to monitor obstetric care.

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Titel: Selective use of episiotomy: what is the impact on perineal trauma? Results from a retrospective cohort study
verfasst von: Massimo Franchi
Francesca Parissone
Cecilia Lazzari
Simone Garzon
Antonio Simone Laganà
Ricciarda Raffaelli
Antonella Cromi
Fabio Ghezzi
Publikationsdatum: 10.12.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Gynecology and Obstetrics / Ausgabe 2/2020
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-019-05404-5

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Selective use of episiotomy: what is the impact on perineal trauma? Results from a retrospective cohort study