Evaluation of episiotomy in present day obstetric practice

Abstract

Background: Episiotomy, a surgically planned incision on the perineum and the posterior vaginal wall during the second stage of labor is one of the most performed surgical procedures in the world, especially for nulliparous women. Episiotomy itself is comparable to a 2nd degree perineal injury. The concept of restrictive episiotomy came where its use is restricted to only high-risk cases such as shoulder dystocia, short rigid perineum, face to pubis delivery, vaginal breech delivery, and instrumental deliveries. We decided to carry out a study to evaluate this common obstetric procedure and try to decipher its role in the present day obstetric practice. Methodology: This was a prospective cohort study on 200 women admitted to the labor room and satisfying the inclusion/exclusion criteria. The cases were then divided into two groups of 100 each by simple randomization by chit method. The participants of one group (Group A) were not given episiotomy unless it was inescapable and was considered as the study group and in the other group (Group B) episiotomy was given to all the patients and was considered as the control group. Results: The overall rate of episiotomy in the control group was 100% as per study protocol and that in study group 27%. The restricted use of episiotomy resulted in a significant reduction in overall episiotomy rate. Conclusion: This study was conducted to evaluate the practice of restrictive episiotomy and compare it with routine episiotomy. We found that the net outcome of restrictive episiotomy was better than routine episiotomy and this was statistically significant with respect to parturition-related perineal trauma, postpartum pain, and maternal satisfaction of the entire birthing process.