Comparing the Rate of Perineal Tears with and Without Episiotomy in Primigravida Women

Neelam Neelam,Afshan Nadeem,Kaneez Fatima,Kiran Batool,Sadia Kadir,Tahira Afzal Durani

doi:10.9734/jpri/2021/v33i29b31590

Abstract

Objective: To compare the frequency of perineal tears (3rd and 4th degree) with and without episiotomy in primigravida women. Setting: Department of Obstetrics and Gynecology at peoples Medical College Hospital (PMCH) Nawabshah. Duration of Study: Six month from March 2015 to September 2015. Study Design: Randomized control trial. Subject and Methods: In this study 322 primigravida women with singleton pregnancy and cephalic presentation were included. The patients were kept in labour room till the second stage of labour. The patients were divided into two groups equally. In Groups-A, right mediolateral episiotomy was performed after infiltration with local anaesthesia at the time of crowing. The Group B in which episiotomy was not given. After delivery, patients were examined for extension of episiotomy in Group A and 3rd and 4th degree perineal tear in both groups. Results: Mean age was 27.83±6.27 years in group A and 27.60±4.93 years in group B (p=0.724). Mean gestational age was 38.17±1.25 weeks was in group A and 38.11±119 weeks in group B (p=0.644). The rate of 3rd and 4th degree perineal tear was significantly higher in group A as compare to group B [60.87% vs. 47.83% p=0.019] and [39.13% vs. 26.09% p=0.013] respectively. Conclusion: Episiotomy was found to be an important risk factor for extension of the perineal tear. It should be practiced only where it is indicated like rigid perineum, any instrumental delivery and shoulder dystocia.

Highlights

Many trial have showed that routine use of episiotomy is correlated with raised risk of trauma, postpartum blood loss, postpartum pain, dyspareunia than those delivered with first and second degree spontaneous tears [10]
A recent research, on the other hand, suggested that episiotomy should be performed with caution and that clinicians should be using perineal protection strategies to mitigate the incidence of perineal pain as well as provide higher comfort zone to the female [13]
After taking above controversial findings this study has been planned to determine the association of perineal tear in normal vaginal delivery of primigravida without episiotomy and with episiotomy, to determine the beneficial effects of episiotomy in primigravida and to bring about change in routine practice of episiotomy and reduce the burden of complications, which occur in normal vaginal delivery of primigravida without episiotomy

Summary

Introduction

Many trial have showed that routine use of episiotomy is correlated with raised risk of trauma, postpartum blood loss, postpartum pain, dyspareunia than those delivered with first and second degree spontaneous tears [10]. Apart from all these there is increased risk of infection, longer healing period, increased chance of gapped wound and increased need for analgesia in patients delivering with episiotomy [11] recently it was stated that While episiotomy is common among primiparous women, higher rates are linked to increased morbidity and a limited benefits [12]. After taking above controversial findings this study has been planned to determine the association of perineal tear in normal vaginal delivery of primigravida without episiotomy and with episiotomy, to determine the beneficial effects of episiotomy in primigravida and to bring about change in routine practice of episiotomy and reduce the burden of complications, which occur in normal vaginal delivery of primigravida without episiotomy

Methods

Results

Conclusion