The Value of Routine Episiotomy in Forceps Deliveries

Abstract

Objective: to determine the risk of third and fourth degree tears if episiotomy precedes operative forceps deliveries.Methods: a retrospective analysis was performed, identifying 319 women who had a forceps delivery. Two hundred and seventy-two women met our inclusion criteria term, singleton, cephalic presentation, with mid, low or outlet forceps). Patients having forceps deliveries with an episiotomy were compared to those with forceps deliveries and no episiotomy. Maternal age, parity, use of an epidural, gestational age, and birth weight were examined for each group. The incidence of third and fourth degree tears and the odds ratio between the two groups were determined.Results: there were no differences in demographic or clinical variables between the two groups. Compared to the patients without episiotomy (n = 46), patients having forceps deliveries with an episiotomy (n = 226) had a significantly higher incidence of third and fourth degree tears (odds ratio 2.8; 95% confidence interval 1.5–5.6).Conclusion: the routine use of episiotomy is possibly associated with an increased incidence of sphincteric injuries in patients undergoing forceps deliveries. The routine use of episiotomy with forceps delivery should be re-evaluated.