The Impact of Episiotomy on Adverse Perinatal Outcomes in Operative Vaginal Deliveries [40J

Abstract

INTRODUCTION: There has been a large reduction in routine episiotomy, thus many provided today are likely clinically indicated. Thus, we sought to investigate the association between episiotomy and adverse perinatal outcomes in operative vaginal births. METHODS: This is a retrospective cohort study of singleton, non-anomalous, term spontaneous vaginal deliveries between 2007 and 2011 using linked vital statistics and ICD-9 data. The neonatal adverse outcomes examined included brachial plexus injury (BPI), clavicular fracture (CVFs), 5-min APGAR score <7, neonatal intensive care unit (NICU) admission, and composite of severe neonatal outcomes (neonatal seizure, APGAR score ≤3, and neonatal death). The maternal adverse outcomes examined included postpartum hemorrhage (PPH), 3rd and 4th-degree perineal lacerations, and maternal blood transfusion (MBTs). Chi-square tests were used to compare rates of perinatal adverse outcomes for births with and without episiotomy. Multivariable logistic regression was used to control for maternal BMI, diabetes status, race/ethnicity, age, education, insurance status, parity, and prenatal care. RESULTS: In a cohort of 161,921 operative vaginal births, we found no statistically significant difference for adverse neonatal outcomes for births with and without episiotomy. Interestingly, women with episiotomy had decreased rates of postpartum hemorrhage, a relationship that remained after controlling for confounders of interest (aOR 0.55, 95% CI 0.35-0.84). CONCLUSION: Our study demonstrates that episiotomy does not improve neonatal outcomes in the setting of operative vaginal delivery and was not associated with severe perineal laceration, but that it may decrease the odds of maternal postpartum hemorrhage. Careful clinical consideration should be exercised when deciding to use an episiotomy.