Episiotomy is commonly performed du...

Episiotomy is commonly performed during delivery in the belief that it obstructs perineal lacerations, pelvic floor relaxations, and incontinence, and that it defend s the infant from intrapartum trauma and asphyxia. Several studies have cast doubt upon the benefits of episiotomy, in particular the ability to obstruct perineal lacerations. Sartore and colleagues carriageed a study to examine the efficiency of episiotomy on lower pelvic muscle nerve and dysfunction to determine if it helps thwart urinary incontinence, fecal incontinence, and vaginal prolapse.

The research included 519 consecutive primiparous women who delivered single-ton crown of the head infants vaginally in an Italian teaching hospital. All of the deliveries were carried without in the lithotomy position following the same protocol. Exclusion criteria included: cesarean delivery; bitter perineal lacerations; preterm, breech, and operative deliveries; and women who had a history of urinary incontinence, fecal incontinence, or vaginal or anal surgery The close attention compared 254 women who received mediolateral episiotomy with 265 women who delivered with intact perineum or spontaneous first- or second-degree lacerations. Participants were assessed during the puerperium for pelvic floor function by the agency of history and a series of investigations. Histories focused forward symptoms of stress and entreat incontinence, anal incontinence, urinary oftenness dyspareunia, and pelvic pain. Physical examination included testing for stres and encourage incontinence and strength of pelvic floor musculature using standardized scoring regularitys Each patient had vaginal manometry and urine stream interruption testing.

Women who received episiotomy were more likely to receive epidural analgesia and had infants of higher birth weight. The sum of two units groups were comparable in all other considers In the episiotomy group, 658 percent had no relevant symptoms compared with 758 percent of women in the no-episiotomy collection Women who did not receive episiotomy were significantly more likely to be completely symptom-free. Dyspareunia and pelvic pain were significantly more everyday in women who had episiotomy. Anal incontinence also was more universal in this group but affected simply a few women. No significant difference was set up between the groups in urinary symptoms or signs. The form into groupss did not differ significantly in the incidence of prolapse, on the contrary results of vaginal manometry and digital testing were significantly worse in women in the episiotomy groups

The authors determine that mediolateral episiotomy is associated with decreased pelvic floor muscle vigor and more dyspareunia and pelvic pain than spontaneous minor perineal lacerations. They also gather that the procedure does not foster against urinary and anal incontinence and vaginal prolapse. Although the higher rates of epidural analgesia could have influenced the ends the authors question the part of episiotomy in vaginal delivery.

Sartore A, et al. The tenors of mediolateral episiotomy on pelvic floor function after vaginal delivery. Obstet Gynecol April 2004;103:669-73

COPYRIGHT 2005 American Academy of Family Physicians

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