Episiotomy Group Research Articles

Effect of different delivery modes on the short-term strength of the pelvic floor muscle in Chinese primipara

BackgroundTo investigate the effect of different delivery modes and related obstetric factors on the short-term strength of the pelvic floor muscle after delivery in Chinese primipara.MethodsA total of 4769 healthy Chinese primiparas at postpartum 6–8 weeks were interviewed. According to the difference of delivery mode, the selected primiparas were divided into 2 groups, including cesarean delivery group containing 2020 and vaginal delivery group containing 2749. All the vaginal deliveries were further divided into 3 groups, including episiotomy group containing 2279, perineal laceration group containing 398, and forceps assisted group containing72. The scales of their pelvic floor muscle (PFM) strengths were examined by specially trained personnel using digital palpation (Modified Oxford scale:0–5 grade). According to participants’ willingness, if the PFM strength was weak (0 or 1 grade), at-home PFM training would be recommended and an electrical stimulation combined with biofeedback therapy would be conducted for them in hospital. Twelve weeks after delivery, the PFM strength would be measured again. For statistical analysis, t-test, one-way variance analysis, Chi-square analysis, Kruskal-Wallis test H, Mann-Whitney U test and Wilcoxon test were carried out.ResultsThe PFM strength in cesarean delivery group was higher than in vaginal delivery group (p < 0.05). Among 3 vaginal delivery groups, the PFM strength in perineal laceration group was the highest (p < 0.05); however, there was no difference in PFM strength between episiotomy group and forceps assisted group (p>0.05). After accepting PFM training at home and therapy in hospital, 305 women showed increased PFM strength (p < 0.05).ConclusionsVaginal delivery is an independent risk factor causing the damage of PFM, and episiotomy may cause injury of PFM. Through PFM training at home and therapy in hospital, those damage will resume as soon as possible in the short-time period after delivery.

Maternal Morbidity in Vaginal Delivery with or without Episiotomy in Nulliparous Women

Introduction: Episiotomy incision is the most common surgical procedure around the globe and in many countries, it became a routine policy. Episiotomy in all women with vaginal delivery has no benefit. Rate of episiotomy varies widely around the globe, while in Nepal all nulliparous and primi-parous hospital deliveries are given routine episiotomy. So, this study aimed to compare the maternal morbidity during first vaginal birth in women with or without episiotomy.Methods: This is a hospital based randomized prospective comparative study conducted in the Obstetrics and Gynaecology department of a teaching hospital. The subjects were divided into episiotomy group and no episiotomy group. Under local anaesthesia mediolateral episiotomy was given in the second stage with crowning of the head in episiotomy group. Nature of morbidity seen were recorded in both the groups immediately after delivery, after 6 hours and after 1 week and compared.Results: In no episiotomy group intact perineum 26.3%, laceration 10.5%, spontaneous perineal tear (first and second degree) 63.1% was observed. Total perineal surgical repair was 81.55%. Intact perineum was high among no episiotomy group. Third degree tear, vulval haematoma, wound gaping, perineal oedema were seen in episiotomy group.Conclusion: Anterior perineal laceration rate was high in no episiotomy group than episiotomy group but overall few morbidities were in no episiotomy group than in episiotomy group. So, episiotomy should not be considered to prevent insignificant anterior perineal lacerations.

No episiotomy versus selective lateral/mediolateral episiotomy (EPITRIAL): an interim analysis.

The objective of this trial was to evaluate whether avoiding episiotomy can decrease the risk of advanced perineal tears. In this randomized (1:1) parallel-group superiority trial, primiparous women underwent randomization into standard care (155 cases) vs. no episiotomy (154 cases) groups. The primary endpoint was the incidence of advanced (3rd- and 4th-degree) perineal tears. Secondary outcomes included perineal integrity, suturing characteristics, second-stage duration, incidence of postpartum hemorrhage, neonatal variables, and various postpartum symptoms 2days and 2months after delivery. At prespecified 1-year interim analysis, the groups did not differ in terms of baseline demographic and obstetric characteristics. Six advanced perineal tears (3.9%) were diagnosed in the standard care group vs. two in no episiotomy group (1.3%), yielding a calculated odds ratio (OR) of 0.33 [95% confidence interval (CI) 0.06-1.65). Unexpectedly, rates of episiotomy performance also did not significantly vary between groups: 26.5% (41 cases) vs. 21.4% (33 cases), respectively, p=0.35. No significant differences were noted in any secondary outcomes. No difference in the rates of advanced perineal tears was found between groups; however, the main limitation of our study was unexpectedly high rates of episiotomy in the nonepisiotomy group. Thus, the main conclusion is that investigator monitoring and education should be continuously practiced throughout the trial duration, stressing the importance of adherence to the protocol.

Selective episiotomy vs. implementation of a non-episiotomy protocol: a randomized clinical trial

BackgroundDespite all the evidence corroborating the selective use of episiotomy and although routine use of the procedure is contraindicated, there are no evidences corroborating if episiotomy is necessary in any circumstance. The present clinical randomized trial was performed to compare maternal and perinatal outcomes in women submitted to a non-episiotomy protocol versus one of selective episiotomy.MethodsAn open-labelled, randomized clinical trial was carried out in a tertiary teaching hospital in Recife, Northeastern Brazil. Women in labor with a full-term live foetus, dilatation of 6 to 8 cm and cephalic presentation (vertex position) were included. Exclusion criteria consisted of bleeding disorders and an indication for a caesarean section. After signing the consent form, 241 women were randomized to a non-episiotomy protocol (the experimental group) or to a selective episiotomy group (the control group). No episiotomies were to be performed in the experimental group except under exceptional circumstances. In the control group, selective episiotomies were to be performed in accordance with the healthcare professionals’ clinical judgement. Maternal and perinatal outcomes were evaluated. Ratio Risk (RR) and the 95% confidence interval (95% CI) were calculated for our outcomes.ResultsThe analysis include 115 women assigned to a non-episiotomy protocol and 122 to selective episiotomy. There was no difference between the two groups with respect to maternal or perinatal outcomes. The episiotomy rate was similar (two cases in each group, about 1.7%), as was the duration of the second stage of labor, the frequency of perineal tears, severe perineal trauma, need for perineal suturing and blood loss at delivery.ConclusionsA non-episiotomy protocol appears to be safe for mother and child, and highlights the need to investigate whether there is, in fact, any indication for this procedure.Trial registrationThis trial was registered at ClinicalTrials.gov under reference number (NCT02178111).

Female Sexual Function after Vaginal Delivery with Episiotomy and Cesarean Section

Objective: To determine the difference of sexual function after vaginal&#x0D; delivery with episiotomy and cesarean section in Sanglah Hospital,&#x0D; Denpasar.&#x0D; Method: This research was conducted using cross sectional method.&#x0D; Sample was collected using consecutive sampling, starting from October 2011-September 2012. Our sample consists of 86 women, 43 post-episiotomy and 43 post-cesarean section. Sexual function was assessed using FSFI (Female Sexual Function Index). Total score was analyzed using independent t-test and difference of sexual function was tested using Chi-square, with significance level p0.05). There was no significant difference between the two groups in term of sexual arousal and lubrication, with p-value 0.160 and 0.67, respectively. However, we found significant difference in other domains, namely desire (p=0.014), orgasm (p=0.045), satisfaction (p=0.018), pain (p=0.02), and total FSFI score (p=0.006). Sexual dysfunction was found in 18.60% of the episiotomy group and 2.33% of the cesarean section group, with p=0.030.&#x0D; Conclusion: Female sexual dysfunction was found to be significantly&#x0D; different between women post vaginal delivery with episiotomy and&#x0D; women who had cesarean section.&#x0D; [Indones J Obstet Gynecol 2014; 4: 199-203]&#x0D; Keywords: cesarean section, episiotomy, female sexual function

Female Sexual Function after Vaginal Delivery with Episiotomy and Cesarean Section

Objective: To determine the difference of sexual function after vaginal&#x0D; delivery with episiotomy and cesarean section in Sanglah Hospital,&#x0D; Denpasar.&#x0D; Method: This research was conducted using cross sectional method.&#x0D; Sample was collected using consecutive sampling, starting from October 2011-September 2012. Our sample consists of 86 women, 43 post-episiotomy and 43 post-cesarean section. Sexual function was assessed using FSFI (Female Sexual Function Index). Total score was analyzed using independent t-test and difference of sexual function was tested using Chi-square, with significance level p0.05). There was no significant difference between the two groups in term of sexual arousal and lubrication, with p-value 0.160 and 0.67, respectively. However, we found significant difference in other domains, namely desire (p=0.014), orgasm (p=0.045), satisfaction (p=0.018), pain (p=0.02), and total FSFI score (p=0.006). Sexual dysfunction was found in 18.60% of the episiotomy group and 2.33% of the cesarean section group, with p=0.030.&#x0D; Conclusion: Female sexual dysfunction was found to be significantly&#x0D; different between women post vaginal delivery with episiotomy and&#x0D; women who had cesarean section.&#x0D; [Indones J Obstet Gynecol 2014; 4: 199-203]&#x0D; Keywords: cesarean section, episiotomy, female sexual function

Episiotomy and the risk of severe perineal injuries among Korean women

Purpose: We examined the frequency of severe perineal injuries according to the use of episiotomy in vaginal deliveries of Korean women.Materials and methods: This is a retrospective cohort study in which 358 consecutive parturients were included. Women were divided into episiotomy (n = 115) and no episiotomy (n = 243) groups. The main outcome was the occurrence of severe (third or fourth degree) perineal injuries. Delivery records and medical documents were reviewed to collect the data. Parametric and nonparametric tests were used as appropriate.Results: There were no significant differences in the frequency of severe perineal injuries between two groups (6.1% (7/115) in episiotomy versus 3.7% (9/243) in no episiotomy group, p = 0.308). Anterior perineal laceration was more frequent (40.3% (98/243) vs. 18.3% (21/115), p < 0.001), but intact perineum was found in 15.6% (38/243) of women in no episiotomy group. Logistic regression analysis was performed to evaluate independent risk factors in the occurrence of severe perineal injuries including maternal age, parity, performance of episiotomy, head position at delivery, length of second stage of labor, birth weight, head circumference, and the use of vacuum during delivery. Only birthweight was a significant factor in predicting severe perineal injuries, and performance of episiotomy did not increase nor decrease the risk of severe perineal injury.Conclusions: There was no difference in the occurrence of severe perineal injuries according to the use of episiotomy.

Effect of delivery without perineum protection on the maternal and neonatal outcomes

Objective To evaluate the effect of delivery without perineum protection on maternal and neonatal outcomes .Methods The current study was conducted between July 1st, 2012 and February 1st, 2013. A total of 701 maternal women were included in the study , and 208 maternal women went on unprotected perineum delivery method and 493 went into routine episiotomy .Maternal and neonatal outcomes at the first day , the first week and the third month after delivery were compared and analyzed between the two groups .Results The aspects of intrapartum hemorrhage , suture material within delivery and the average hospitalization days in unprotected perineum group were significantly lower than those in the routine episiotomy group （ t= -14.58,-97.07,-21.88, respectively;P〈0.01）.The rate of episiotomy was 24.04%（50/208） in the unprotected perineum group and 61.26% （302/493） in the routine episiotomy group, and the difference was statistically significant （χ2 =81.06,P〈0.01）.In the unprotected perineum group ,65, 44, 93 and 6 patients had perineal integrity, incision, laceration and incision with laceration , which in the routine episiotomy group were 78,269, 113 and 33, respectively, and the difference was significant （χ2 =81.09,P〈0.01）.The perineal pain at the first day,the first week and the third month after delivery were significantly different between two groups （χ2 =82.95,32.51,5.58, respectively;P〈0.01）.The incidence of postpartum urinary retention （χ2 =10.07,P〈0.01）, healing complications （χ2 =18.79,P〈0.01） at first week and painful sex （χ2 =18.83,P〈0.01） in the unprotected perineum group were significantly lower than those in the routine episiotomy group .There were no significant differences between the two groups with the aspects of time of the first （ t=-1.72,P〉0.05） and the second stage of birth （t=1.55,P〉0.05）, neonatal birth weight （t =0.91,P 〉0.05）, Apgar scores （χ2 =0.10,P〉0.05） and NICU admission （χ2 =0.60,P〉0.05）.Conclusions The unprotected perineum delivery could decrease short-term and long-term complications , and it can be a new idea of restrictive episiotomy. Key words: Delivery; Unprotected perineum delivery; Routine episiotomy delivery; Maternal and neonatal outcomes

Primipara Undergoing Episiotomy had Lower Postpartum Sexual Function

Objective: To compare postpartum sexual functions between primipara with episiotomy and without episiotomy.&#x0D; Method: The research was conducted in public service section of Dr. Wahidin Sudiro Husodo hospital and a number of educational hospitals obstetrics and gynecology of Faculty of Medicine of Hasanuddin University, started from February to May 2012. The research evaluated the sexual function of postpartum with episiotomy in 171 primipara, and 150 primipara postpartum without episiotomy. Sexual function was measured by Female Sexual Function Index (FSFI) questionnaire which had been validated in various countries. The research was conducted with cross sectional approach. Samples were withdrawn with consecutive sampling method. The data was processed with SPSS version 17, with chi-square test, and significant level of 0.05.&#x0D; Result: Indicated that either the episiotomy or non-episiotomy group has undisturbed sexual function score (&gt;28.5), however, higher score was indicated in non-episiotomy group (65.477) compared to the episiotomy group (59.70), (p&lt;0.05).&#x0D; Conclusion: Primipara with episiotomy and breastfeeding has lower sexual functions compared to the non-breastfeeding group, however, it was statistically insignificant (p&gt;0.05).&#x0D; Keywords: episiotomy, FSFI, primipara, sexual functions

Prevalence and predictors of episiotomy among women at first birth in enugu, South-East Nigeria.

Background:Women having their first birth have a higher risk of episiotomies. Therefore, the study of the procedure in this group of at risk women will assist in solving some of its associated controversies.Aim:The aim was to determine the prevalence, predictors, and outcomes of episiotomy among primigravid women in Enugu, Nigeria.Materials and Methods:The study was a retrospective cross-sectional review of labor ward records of women that had their first delivery at the University of Nigeria Teaching Hospital (UNTH) Enugu, over a 5-year of April 204 to March 2009. Only women that had a vaginal delivery were included in the study. Mann–Whitney U-test (continuous data) and Chi-square test (categorical data) were used for data analysis.Results:Prevalence of episiotomy in the study was 62.1% (411/662). The episiotomy rate for booked women (65.6%, 376/573) was significantly higher than that of unbooked women (39.3%, 35/89), (prevalence ratio = 1.67 [95% confidence interval: 1.28, 2.17]). The birth weights of babies delivered in the episiotomy group (median = 3.2 kg [interquartile range (IQR): 2.9-3.5]) was statistically higher than those of women who did not receive episiotomy (median, 3.1 kg [IQR: 2.7-3.4]), (Z = -3.415, P = 0.001). Proportion of newborns with low 1st min Apgar scores in the episiotomy group (21.7%, 89/411) was significantly lower than the no episiotomy group (15.1%, 38/251) (P = 0.04).Conclusion:Prevalence of episiotomy among women that had their first births in the UNTH, Enugu was high, and the predictors included booked status of women, higher gestational age at delivery, and larger neonatal birth weight. More efforts should be made to reduce episiotomy rate in the hospital.

Sexual function after childbirth by the mode of delivery: a prospective study

The objective of the present study was to evaluate sexual behavior longitudinally in the postpartum period by mode of delivery. In this prospective study, five groups were defined: women who delivered vaginally without an episiotomy (n=16), women who delivered vaginally with an episiotomy (n=14), women who delivered by instrumental delivery (n=16), women who delivered by an emergent cesarean section (n=19), and women who delivered by an elective cesarean section (n=17). Sexual behavior was assessed by the female sexual function index (FSFI) questionnaire at 6, 12, and 24weeks postpartum and by the timing of resumption of sexual intercourse. The mean±SD self-reported timing of resumption of sexual activity was 4.5±1.8, 7.9±3.0, 7.3±3.4, 6.1±2.6, and 6.1±2.4weeks in the vaginal delivery without an episiotomy group, in the vaginal delivery with an episiotomy group, in the instrumental delivery group, in the elective cesarean delivery group, and in the emergent cesarean delivery group, respectively (p=0.013). The FSFI total score in the entire study group (n=82) was 14.1±10.8, 24.6±7.6, and 27.7±5.1 at 6, 12, and 24weeks postpartum, respectively (p<0.05). The FSFI total score did not differ significantly across types of mode of delivery at 6, 12, or 24weeks postpartum. The significance by delivery mode difference in the postpartum resumption of sexual activity was not accompanied by difference in sexual function scores. Specifically, elective cesarean delivery was not associated with a protective effect on sexual function after childbirth.

Comparison of the effects of episiotomy and no episiotomy on pain, urinary incontinence, and sexual function 3 months postpartum: A prospective follow-up study

Background The episiotomy rate has declined worldwide but remains high in several countries such as Taiwan. The effects of episiotomy on women's health should be a constant concern. Few data are available on the effect of episiotomy by validated measures. Objective The present study examined the effect of episiotomy on pain, urinary incontinence, and sexual function up to 3 months postpartum. Design, setting and participants A prospective follow-up study of 243 women who completed the Taiwanese versions of the Short Form McGill Pain Questionnaire, International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form, Female Sexual Function Index, and a demographic questionnaire after vaginal delivery in a Taiwanese medical center. Methods Differences between those who did and did not have an episiotomy were tested using ANCOVA, adjusting for age, parity, newborn weight, and vacuum delivery. The reliability and validity of the measuring instruments were assessed using Cronbach's α coefficient and factor analysis. Results Women who delivered without an episiotomy had significantly lower perineal pain scores at weeks 1, 2 and 6 postpartum compared to women who had an episiotomy ( p = 0.0065, 0.0391, 0.0497, respectively). Women in the no-episiotomy group had significantly lower non-localized pain scores at week 2 postpartum compared to women in the episiotomy group ( p = 0.0438). The mean urinary incontinence score was significantly higher in the episiotomy group 3 months postpartum ( p = 0.0293). No significant difference in sexual function score was found between groups. Conclusions The results indicate that episiotomy increased pain at weeks 1, 2 and 6 postpartum, and urinary incontinence at 3 months postpartum. Awareness of the relationship between episiotomy and women's health will help health care professionals develop policy and promote the application of restrictive episiotomy.

Is the policy of restrictive episiotomy generalisable? A prospective observational study

Objective. To assess whether the policy of restrictive episiotomy could be safely implemented in Chinese population, and whether perineal length was related to risk of perineal tear during spontaneous vaginal deliveryMethods. A prospective observational study was conducted between November 2007 and February 2008. A restrictive approach of episiotomy was implemented in those Chinese women who carried an uncomplicated singleton cephalic presenting pregnancy in labour. Perineal length (PL) was measured at three time points: (A) at early first stage of labour; (B) at the beginning of the second stage; (C) at crowning. Women with and without perineal tears were compared with reference to PL measured at different stages and its stretching performance (defined by the change in PL between different stages).Results. Among the 429 women recruited, mean PL at point A, B and C was 38.8 mm (±7.9), 49.4 mm (±8.1) and 59.4 mm (±9.4), respectively, which were similar to those reported in other countries. Episiotomy rate reduced from 73.3 to 26.8%. Among the non-episiotomy group, 13.7% had no perineal tear, 86.3% had minor (first or second degree) tears but none had major tears, whilst 3.5% and 0.9% of episiotomy group had minor and major tears, respectively. PL was not associated with the risk of perineal tear.Conclusions. Restrictive episiotomy reduces the episiotomy rate without compromising the perineal safety. Chinese women's PL is not shorter than other races, or is predictive of perineal tears.

A comparison of sexual outcomes in primiparous women experiencing vaginal and caesarean births

Background and Objective:We conducted this study to evaluate and compare postpartum sexual functioning after vaginal and caesarean births.Materials and Methods:This was a cross-sectional study that was carried out in postnatal health care in a hospital. A total of 50 primiprous women who had given birth 6-12 months ago and came to the hospital for postnatal care were asked to join the study. Forty of the women completed the entire questionnaire. Among these women, 20 delivered spontaneously with mediolateral episiotomy and 20 had elective caesarean section. Sexual function was evaluated by a validated, self-created questionnaire. A statistical evaluation was carried out by SPSS v.11. A two-part self-created validated questionnaire for data collection was administered regarding sexual function prior to pregnancy and 6-12 months postpartum.Results:The median time to restart intercourse in the normal vaginal delivery with episiotomy (NVD/epi) group was 40 days and in the caesarean section (C/S) group was 10 days postpartum. The most common problems in the NVD/epi group was decreased libido (80%), sexual dissatisfaction (65%), and vaginal looseness (55%). In the C/S group, the most common problems were vaginal dryness (85%), sexual dissatisfaction (60%), and decreased libido (35%). There were clinically significant differences between the two groups regarding sexual outcomes, but these differences were not statically significant.Conclusion:Postnatal sexual problems were very common after both NVD/epi and C/S. Because sexual problems are so prevalent during the postpartum period, clinicians should draw more attention to the women's sexual life and try to improve their quality of life after delivery.

Selective vs routine midline episiotomy for the prevention of third- or fourth-degree lacerations in nulliparous women

The purpose of this study was to determine whether selective midline episiotomy contributes to the prevention of third- or fourth-degree perineal lacerations. A randomized controlled clinical trial was performed with 446 nulliparous women with deliveries after 28 weeks of pregnancy. Patients were randomized to undergo either routine episiotomy or selective episiotomy. In the selective episiotomy group, episiotomies were performed only in cases of imminent lacerations, fetal distress, or forceps delivery. In the group of 223 patients who underwent routine episiotomy, 32 (14.3%) had third- or fourth-degree perineal lacerations, as compared to 15 (6.8%) in the group of 222 patients undergoing selective episiotomy (relative risk, 2.12; 95% confidence interval, 1.18-3.81). Only reduction in third-degree lacerations was significant when analyzed separately. Moreover, periurethral, labia minora, and superficial vaginal lacerations were significantly more frequent in the selective episiotomy group. The policy of performing selective midline episiotomy in nulliparous patients results in a reduction in the risk of third-degree perineal lacerations.

Effect of Timing of Episiotomy Repair on Peripartum Blood Loss

Background: To evaluate the effect of timing of episiotomy repair on peripartum blood loss. Method: In this case-controlled study, nulliparous women were grouped as: group 1: no episiotomy (control; n = 82); group 2: midline episiotomy repair after placental removal (n = 76); group 3: midline episiotomy repair before placental removal (n = 78); group 4: mediolateral episiotomy repair after placental removal (n = 84), and group 5: mediolateral episiotomy repair before placental removal (n = 80). Hemoglobin and hematocrit values were evaluated at admission and 24 h postpartum. Results: The reductions in hemoglobin and hematocrit in all episiotomy groups (groups 2–5) were significantly more than that of control (group 1) (p < 0.05). There was no difference among midline episiotomy groups (groups 2 and 3) whereas a significant difference existed among mediolateral groups (groups 4 and 5) (p < 0.05). When episiotomy repair was done after placental removal, there was a significant difference between midline and mediolateral techniques (groups 2 and 4) (p < 0.05). When repair was done before placental removal, there was no difference in the amount of blood loss regardless of technique (between groups 3 and 5). Conclusion: Episiotomy should be avoided to decrease the amount of peripartum blood loss. However, if mediolateral episiotomy is to be performed, it should be repaired before placental removal to decrease the amount of peripartum blood loss.

Shoulder Dystocia at Noninstrumental Vaginal Delivery

This study examines the relationship between episiotomy and the occurrence of shoulder dystocia among noninstrumental vaginal deliveries. Analysis of data from a retrospective database was used to study noninstrumental vaginal deliveries in New Jersey during the years 1996 to 2001. The episiotomy group and nonepisiotomy group were analyzed separately using univariate and multivariate analysis. Among 358,664 deliveries, rate of shoulder dystocia was 1.0% (n = 3596). Thirty-five percent of deliveries were assisted by episiotomy. Rate of dystocia was 1.42% with the use of episiotomy, and 0.81% when episiotomy was not used. This increased rate with episiotomy was noted across all of the racial groups, all birthweight categories, and all of the risk factor subgroups analyzed. There was a gradual decrease in the use of episiotomy from 37.30 to 26.03% without a corresponding increase in the rate of dystocia. Among noninstrumental deliveries, the rate of shoulder dystocia is higher in the episiotomy group. Decrease in the use of episiotomy has not resulted in an increase in the occurrence of dystocia.

The effect of mode of delivery on postpartum sexual functioning in primiparous women

The objective of this paper is to evaluate the effect of mode of delivery on postpartum sexual functioning in primiparous women. A total of 248 primiparous women were recruited into this study. One hundred fifty-six delivered spontaneously with mediolateral episiotomy and 92 had elective cesarean section. Sexual function was evaluated by the Female Sexual Function Index, a validated questionnaire separately evaluating desire, lubrication, orgasm, satisfaction, and pain. Subjects were questioned relating their pre-pregnancy experiences during the first antenatal visit when the pregnancy was not more than six gestational weeks. The test was repeated 6 months postpartum. Statistical evaluation was carried out by SPSS for Windows v.11. In the vaginal delivery with mediolateral episiotomy group, there were significant decreases in the scores 6 months after delivery when compared to scores before pregnancy (p<0.001). In the cesarean section group, no difference was observed between pre-pregnancy and postpartum scores (p>0.05). When the two groups were compared, there was a significant difference between 6 months postpartum scores (p<0.001). Not only pain, but also other important aspects of sexual function, such as arousal, lubrication, orgasm, and satisfaction are affected by performing mediolateral episiotomy during vaginal delivery, well beyond the puerperal period. Concerning its effects on postpartum sexual functioning, a policy of restricting mediolateral episiotomy use should be adopted.

Effects of episiotomy on bonding and mothers' health.

Historically, episiotomy has been carried out during labour to facilitate delivery, shorten the duration of the second stage and prevent spontaneous lacerations. However, recent studies of episiotomy have recommended that it be carried out only when necessary. In Turkey, midwives are authorized to perform episiotomy. To analyse the effects of episiotomy on mothers' health and mother-infant bonding. A cohort study of 100 women who gave birth by normal vaginal delivery in a Turkish hospital between 15 March 1999 and 6 April 2000. Participants were divided into episiotomy (n = 50) and control (n = 50) groups. Data on biographical characteristics and the process of labour were collected in hospital, and follow-up was conducted at home 1, 3 and 12 weeks after labour. Mean duration of the second stage was longer in the episiotomy group than the control group, but the difference was not significant. The number of spontaneous lacerations was significantly lower in the episiotomy group. Mean time from delivery to maternal rest and time taken to bond with the infant were significantly longer in the episiotomy group. There were significantly higher scores for overall incidence and severity of pain on the first day, and pain incidence and severity at 1 week in the episiotomy group. Significantly fewer women in the episiotomy group were able to do chores and to sit/stand up comfortably in the first postpartum week Episiotomy should not be used unless indicated. Measures should be taken to avoid perineal trauma during labour, establish bonding between mother and infant as soon as possible, and minimize perineal discomfort after delivery.

Episiotomy for vaginal birth.

Episiotomy is done to prevent severe perineal tears, but its routine use has been questioned. The relative effects of midline compared with midlateral episiotomy are unclear. The objective of this review was to assess the effects of restrictive use of episiotomy compared with routine episiotomy during vaginal birth. We searched the Cochrane Pregnancy and Childbirth Group trials register. Randomised trials comparing restrictive use of episiotomy with routine use of episiotomy; restrictive use of mediolateral episiotomy versus routine mediolateral episiotomy; restrictive use of midline episiotomy versus routine midline episiotomy; and use of midline episiotomy versus mediolateral episiotomy. Trial quality was assessed and data were extracted independently by two reviewers. Six studies were included. In the routine episiotomy group, 72.7% (1752/2409) of women had episiotomies, while the rate in the restrictive episiotomy group was 27.6% (673/2441). Compared with routine use, restrictive episiotomy involved less posterior perineal trauma (relative risk 0. 88, 95% confidence interval 0.84 to 0.92), less suturing (relative risk 0.74, 95% confidence interval 0.71 to 0.77) and fewer healing complications (relative risk 0.69, 95% confidence interval 0.56 to 0.85). Restrictive episiotomy was associated with more anterior perineal trauma (relative risk 1.79, 95% 1.55 to 2.07). There was no difference in severe vaginal or perineal trauma (relative risk 1.11, 95% confidence interval 0.83 to 1.50); dyspareunia (relative risk 1.02, 95% confidence interval 0.90 to 1.16); urinary incontinence (relative risk 0.98, 95% confidence interval 0.79 to 1.20) or several pain measures. Results for restrictive versus routine mediolateral versus midline episiotomy were similar to the overall comparison. Restrictive episiotomy policies appear to have a number of benefits compared to routine episiotomy policies. There is less posterior perineal trauma, less suturing and fewer complications, no difference for most pain measures and severe vaginal or perineal trauma, but there was an increased risk of anterior perineal trauma with restrictive episiotomy.