658: Prophylactic episiotomy for prevention of perineal tears in women with high striae gravidarum score

Abstract

Our study aims to assess the role of prophylactic episiotomy in multiparous women with high striae gravidarum score as a preventive measure for perineal tears Randomized controlled study. We included multiparous women with singleton full-term pregnancy. Striae gravidarum (SG) score was assessed according to Atwal score at four body site (Abdomen, breast, buttocks, hips). Women with moderate or severe SG (Total score >12) were randomized to Group (A): episiotomy was done after crowning of the fetal head during the second stage of labour and Group (B): no episiotomy was done. The primary outcome was the rate of third and fourth perineal tears. the secondary outcomes included the rate of first and second degree perineal tears, para-urethral tears, vaginal tears, cervical tears, number and length of perineal tears. Two-hundred fifty women were included in the study. The final analysis included 114 patients in group A and 119 patients in group B who delivered vaginally. Both groups were similar regarding the baseline characteristics (p >0.05). No statistical significant difference between both groups regarding the total striae score and the individual scores at each body site. Moreover, no difference between both groups regarding the duration of second stage of labor (p =0.121) and the neonatal birth weight (p = 0.827). The overall incidence of perineal tears was significantly high in women delivered without episiotomy than episiotomy group (90.4% vs. 23.5% respectively, p<0.001). In addition, the incidence of third and fourth degree perineal tears was significantly higher in delivery without episiotomy group (15% vs. 3.3%, p=0001). Similarly, the incidence of first and second degree perineal tears was significantly higher in delivery without episiotomy group (75.4% vs 20.2%, p=0.001) than episiotomy group. No statistical significant difference between both groups regarding the incidence of para-urethral, vaginal and cervical tears (p=0.127, 0.294 and 0.164 respectively). Additionally, no difference in the incidence of multiple tears (p=0.742) and the length of tears between both groups (p=0.284). Prophylactic episiotomy in multiparous women with high SG score seems to be an effective method in decreasing the rate of perineal tears during vaginal delivery especially the third and fourth degree perineal tears