Is there a benefit to episiotomy at spontaneous vaginal delivery? A natural experiment.

Abstract

OBJECTIVE:

Our purpose was to examine the association between maternal vaginal and perineal morbidity and episiotomy performed at spontaneous vaginal delivery.

STUDY DESIGN:

We obtained data from 17,483 consecutive spontaneous vaginal deliveries and compared the yearly rates of episiotomy, lacerations, and potential confounders with linear regression and stratified analyses.

RESULTS:

Between 1976 and 1994 the use of episiotomy fell significantly (86.8% to 10.4%, R2 = 0.92, p = 0.0001). This change was associated with a fall in the rate of third- and fourth-degree lacerations (9.0% to 4.2%, R2 = 0.59, p = 0.0001) and a rise in the rate of intact perinea (10.3% to 26.5%, R2 = 0.68, p = 0.0001) and vaginal lacerations (5.4% to 19.3%, R2 = 0.77, p = 0.0001). These associations held in separate analyses stratified by parity and birth weight, except for the subgroup of nulliparous women with macrosomic infants.

CONCLUSION:

At our institution a large reduction in the use of episiotomy in spontaneous vaginal deliveries was associated with a significant reduction in perineal trauma in all groups of women except for nulliparous women with macrosomic infants.

• Authors: R K Bansal, W M Tan, J L Ecker, J T Bishop, S J Kilpatrick
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 175 Issue 4 Pt 1 Pg. 897-901 (Oct 1996) ISSN: 0002-9378 [Print] United States
• PMID: 8885744 (Publication Type: Journal Article)

Topics

• Episiotomy (adverse effects, statistics & numerical data)
• Evaluation Studies as Topic
• Female
• Fetal Macrosomia (complications)
• Humans
• Parity
• Perineum (injuries)
• Pregnancy
• Regression Analysis
• Vagina (injuries)
• Wounds, Penetrating (epidemiology, etiology)