Episiotomy: Difference between revisions
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== Types of Episiotomy == | == Types of Episiotomy == | ||
Episiotomy is classified into following types: | |||
* Midline | * Midline | ||
* Mediolateral | * Mediolateral | ||
* Lateral | * Lateral | ||
* the modified-median, | |||
* J-shaped, | |||
* anterior, and radical | |||
== Indication == | == Indication == | ||
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* incision-related scars in the genital area<ref name=":2" />, | * incision-related scars in the genital area<ref name=":2" />, | ||
* poorly healed or 4th degree tears, and fetal distress,<ref name=":2" /> | * poorly healed or 4th degree tears, and fetal distress,<ref name=":2" /> | ||
* | * when there is poor perineal tissue elasticity, that perineal tear seems unavoidable,<ref name=":3">Yang J, Bai H. [https://bmjopen.bmj.com/content/11/4/e043596 Knowledge, attitude and experience of episiotomy practice among obstetricians and midwives: a cross-sectional study from China.] BMJ open. 2021 Apr 1;11(4):e043596.</ref> | ||
* research based on the traditional views is of the opinion that the Asian women have shorter perineal length than Caucasians, putting them at increased risk of tears,<ref name=":3" /> | * or short perineal length, research based on the traditional views is of the opinion that the Asian women have shorter perineal length than Caucasians, putting them at increased risk of tears,<ref name=":3" /> | ||
There are varying beliefs about the benefits of this procedure. | There are varying beliefs about the benefits of this procedure. | ||
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* reduced risk of fecal and urinary incontinence, | * reduced risk of fecal and urinary incontinence, | ||
* ease of repair and better healing than laceration because it is a straight and clean incision | * ease of repair and better healing than laceration because it is a straight and clean incision | ||
| Line 47: | Line 47: | ||
== Complication == | == Complication == | ||
Complications include<ref name=":5">Huy NV. [https://www.smoa.jsexmed.org/article/S2050-1161(19)30193-X/fulltext Pelvic floor and sexual dysfunction after vaginal birth with episiotomy in vietnamese women.] Sexual medicine. 2019 Dec 1;7(4):514-21.</ref><ref name=":6">Barjon K, Mahdy H. [https://www.ncbi.nlm.nih.gov/books/NBK546675/ Episiotomy.] InStatPearls [Internet] 2021 Jul 31. StatPearls Publishing.</ref>: | |||
* pain while sitting (30.4%) was the most prominent trouble, | * bleeding | ||
* infection | |||
* prolonged wound healing, | |||
* dyspareunia, | |||
* pelvic floor dysfunction | |||
* urinary fistulas, and | |||
* inappropriate wound scarring | |||
According to a study carried out to evaluate early complications, pelvic floor, and sexual dysfunction after delivery with episiotomy and their associated factors in Vietnamese women, pain while sitting (30.4%) was the most prominent trouble, pelvic disorders, such as urinary incontinence (11.4%), urinary retention (10.8%), or flatus incontinence (8.9%), were also observed in a remarkable number of participants and sexual dysfunction was 40.7% with trouble occurring commonly in the domains of desire (68.9%) and pain (58.5%)<ref name=":5" /> | |||
== Contraindications == | == Contraindications == | ||
== Clinical Significance == | == Clinical Significance == | ||
Episiotomy was first introduced in the 18th century. The rate increased gradually in the first half of the 20th century worldwide. Different opinions exists about the applicability of episiotomy. Traditional views suggest that routine episiotomy reduces the pressure of the fetal head on the pelvic floor tissues and prevents third-degree or fourth-degree perineal laceration. It is easy to suture because an open wound is smoother than a spontaneous wound<ref name=":3" />. However, there are published reports that claim that episiotomy had no such benefits and large studies stress that routine implementation of episiotomy should be abandoned<ref name=":4">Živković K, Živković N, Župić T, Hodžić D, Mandić V, Orešković S. [https://hrcak.srce.hr/file/262269 Effect of delivery and episiotomy on the emergence of urinary incontinence in women: review of literature]. Acta Clinica Croatica. 2016 Dec 11;55(4).</ref> As a matter of fact, an episiotomy is essentially a type of birth injury. It does not reduce the incidence of severe perineal lacerations. Instead, research suggests that it increases the risk of complications, including perineal tears, perineal pain (compared with no laceration), puerperal infection, postpartum hemorrhage, and later dyspareunia. Therefore, many obstetricians have begun to limit the use of episiotomy in recent years.<ref name=":0" /><ref name=":4" /> | Episiotomy was first introduced in the 18th century. The rate increased gradually in the first half of the 20th century worldwide. Different opinions exists about the applicability of episiotomy. Traditional views suggest that routine episiotomy reduces the pressure of the fetal head on the pelvic floor tissues and prevents third-degree or fourth-degree perineal laceration. It is easy to suture because an open wound is smoother than a spontaneous wound<ref name=":3" />. However, there are published reports that claim that episiotomy had no such benefits and large studies stress that routine implementation of episiotomy should be abandoned<ref name=":4">Živković K, Živković N, Župić T, Hodžić D, Mandić V, Orešković S. [https://hrcak.srce.hr/file/262269 Effect of delivery and episiotomy on the emergence of urinary incontinence in women: review of literature]. Acta Clinica Croatica. 2016 Dec 11;55(4).</ref> As a matter of fact, an episiotomy is essentially a type of birth injury. It does not reduce the incidence of severe perineal lacerations. Instead, research suggests that it increases the risk of complications, including perineal tears, perineal pain (compared with no laceration), puerperal infection, postpartum hemorrhage, and later dyspareunia. Therefore, the clinician must ensure that the benefits of the procedure outweigh the risks during the decision-making process. It is seen that many obstetricians have begun to limit the use of episiotomy in recent years.<ref name=":0" /><ref name=":4" /><ref name=":6" /> | ||
== References == | == References == | ||
<references /> | <references /> | ||
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Description[edit | edit source]
An episiotomy is the most common obstetric surgical procedure performed in the second stage of labor. [1]It is done to reduce the incidence of severe perineal tears (third and fourth-degree) during labor. A controlled incision is made in the perineum to enlarge the vaginal orifice, thereby facilitating a difficult delivery resulting in an easily repairable incision compared to an uncontrolled vaginal trauma. WHO does not recommend routine or liberal use of episiotomy for women undergoing spontaneous vaginal birth[2]
Types of Episiotomy[edit | edit source]
Episiotomy is classified into following types:
- Midline
- Mediolateral
- Lateral
- the modified-median,
- J-shaped,
- anterior, and radical
Indication[edit | edit source]
Episiotomy is suggested to be administered during difficult vaginal deliveries to control and avoid potentially perineal lacerations at the time of delivery.
It is done in conditions such as:
- complicated vaginal deliveries (breech, shoulder dystocia, forceps, vacuum),[3]
- incision-related scars in the genital area[3],
- poorly healed or 4th degree tears, and fetal distress,[3]
- when there is poor perineal tissue elasticity, that perineal tear seems unavoidable,[4]
- or short perineal length, research based on the traditional views is of the opinion that the Asian women have shorter perineal length than Caucasians, putting them at increased risk of tears,[4]
There are varying beliefs about the benefits of this procedure.
Benefits thought for the mother are:[5][6]
- reduction in the likelihood of third degree perineal tears,
- the preservation of the muscle relaxation of the pelvic floor and perineum leading to improved sexual function,
- reduced risk of fecal and urinary incontinence,
- ease of repair and better healing than laceration because it is a straight and clean incision
Benefits for the baby:
It is also suggested that episiotomy increases the APGAR score of the baby, reduces the prolonged second stage and may also reduce the possibility of fetal shoulder dystocia. In some cases, rigid perineum could lead to fetal asphyxia, cranial trauma, cerebral hemorrhage, and mental retardation.[5][6]
Complication[edit | edit source]
- bleeding
- infection
- prolonged wound healing,
- dyspareunia,
- pelvic floor dysfunction
- urinary fistulas, and
- inappropriate wound scarring
According to a study carried out to evaluate early complications, pelvic floor, and sexual dysfunction after delivery with episiotomy and their associated factors in Vietnamese women, pain while sitting (30.4%) was the most prominent trouble, pelvic disorders, such as urinary incontinence (11.4%), urinary retention (10.8%), or flatus incontinence (8.9%), were also observed in a remarkable number of participants and sexual dysfunction was 40.7% with trouble occurring commonly in the domains of desire (68.9%) and pain (58.5%)[7]
Contraindications[edit | edit source]
Clinical Significance[edit | edit source]
Episiotomy was first introduced in the 18th century. The rate increased gradually in the first half of the 20th century worldwide. Different opinions exists about the applicability of episiotomy. Traditional views suggest that routine episiotomy reduces the pressure of the fetal head on the pelvic floor tissues and prevents third-degree or fourth-degree perineal laceration. It is easy to suture because an open wound is smoother than a spontaneous wound[4]. However, there are published reports that claim that episiotomy had no such benefits and large studies stress that routine implementation of episiotomy should be abandoned[9] As a matter of fact, an episiotomy is essentially a type of birth injury. It does not reduce the incidence of severe perineal lacerations. Instead, research suggests that it increases the risk of complications, including perineal tears, perineal pain (compared with no laceration), puerperal infection, postpartum hemorrhage, and later dyspareunia. Therefore, the clinician must ensure that the benefits of the procedure outweigh the risks during the decision-making process. It is seen that many obstetricians have begun to limit the use of episiotomy in recent years.[5][9][8]
References[edit | edit source]
- ↑ Langrová P, Vrublová Y. Relationship between episiotomy and prevalence of urinary incontinence in women 2-5 years after childbirth. small. 2014;90:98.
- ↑ WHO recommendations Intrapartum care for a positive childbirth experiencehttps://apps.who.int/iris/bitstream/handle/10665/272447/WHO-RHR-18.12-eng.pdf Accessed on 25/05/22
- ↑ 3.0 3.1 3.2 Kartal B, Kızılırmak A, Calpbinici P, Demir G. Retrospective analysis of episiotomy prevalence. Journal of the Turkish German Gynecological Association. 2017 Dec;18(4):190.
- ↑ 4.0 4.1 4.2 Yang J, Bai H. Knowledge, attitude and experience of episiotomy practice among obstetricians and midwives: a cross-sectional study from China. BMJ open. 2021 Apr 1;11(4):e043596.
- ↑ 5.0 5.1 5.2 Izuka EO, Dim CC, Chigbu CO, Obiora-Izuka CE. Prevalence and predictors of episiotomy among women at first birth in Enugu, south east Nigeria. Annals of medical and health sciences research. 2014;4(6):928-32.
- ↑ 6.0 6.1 Carroli G. Mignini l. Episiotomy for vaginal birth (Cochrane Review). The Cochrane Collaboration and published in The Cochrane Library. 2009.
- ↑ 7.0 7.1 Huy NV. Pelvic floor and sexual dysfunction after vaginal birth with episiotomy in vietnamese women. Sexual medicine. 2019 Dec 1;7(4):514-21.
- ↑ 8.0 8.1 Barjon K, Mahdy H. Episiotomy. InStatPearls [Internet] 2021 Jul 31. StatPearls Publishing.
- ↑ 9.0 9.1 Živković K, Živković N, Župić T, Hodžić D, Mandić V, Orešković S. Effect of delivery and episiotomy on the emergence of urinary incontinence in women: review of literature. Acta Clinica Croatica. 2016 Dec 11;55(4).
