Best approach to episiotomy unclear

NEW YORK (Reuters Health) - A pilot study of routine versus restrictive use of episiotomy during operative vaginal delivery has not provided conclusive evidence for the superiority of either approach, Irish and UK researchers report.

Operative vaginal delivery refers to a delivery in which the obstetrician uses forceps or a vacuum device to assist the woman in delivering her baby. Traditionally, episiotomy — an incision of the perineum intended to prevent tearing during the delivery of the baby –has been routine when operative vaginal delivery is required.

However, despite no rigorous formal evaluation, an increasing number of obstetricians are using the approach in a restrictive manner, i.e., only if tearing becomes apparent, according to Dr. D. J. Murphy of the University of Dublin and colleagues.

To compare the two strategies, they randomized 200 women who required operative vaginal delivery to routine or restrictive use of episiotomy.

There were no striking outcome differences between the routine or restrictive groups. Anal tears were seen in 8.1 percent of the routine group and 10.9 percent of the restrictive group.

Primary and postpartum bleeding occurred in 36.4 percent of women in the routine group and 26.7 percent of women in the restrictive group. For neonatal trauma, the rates were 45.5 percent and 43.6 percent, respectively.

The incidence of urinary and fecal incontinence, perineal infection and a prolonged hospital stay were also similar.

Overall, say the investigators, “The results are compatible with both clinically significant benefits and harms from routine episiotomy.”

SOURCE: BJOG (British Journal of Obstetrics and Gynecology, December 2008.


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