Whether selective or routine episiotomy is more useful to protect anal sphincter in primiparous women

ABSTRACT

Perineal trauma is a common event, affecting up to 90% of first time mothers. It is a cause for concern for many women and in some countries has led to a large increase in the numbers of women requesting elective caesarean section. To highlight when episiotomy can be useful in preventing anal sphincter injury in primiparous women. This study is a prospective interventional clinical study conducted at AL-Elwiya Maternity Teaching Hospital in Baghdad throughout the period between Jan. 2009-Dec. 2009. Three hundred term primiparous ladies at time of their delivery with cephalic presentation were collected and subdivided into 3 equal groups randomly. The first group, women who were subjected to routine mediolateral episiotomy, while the second group of the participants were delivered without doing episiotomy, and the third group, a mediolateral episiotomy was done selectively to them when we found it is necessary [selective episiotomy]. State of the perineum, length of 2[nd] stage, weight of the baby, fetal head position and the occurrence of anal sphincter injury were all notified and carefully recorded on special form designed for the study. Selective episiotomy was found to be more useful than routine episiotomy in preventing anal sphincter injury [the incidence of anal sphincter injury was 2% for those in whom episiotomy was performed selectively, while it is 8% for those with routine episiotomy and 7% for those delivered without episiotomy], and the difference is statistically significant [P value 0.045]. There was a significant effect of the length of second stage of labour on the incidence of anal sphincter injury [P value 0.017], similarly for the weight of baby [P value 0.017]. Selective episiotomy is more useful intervention than routine episiotomy in protecting the anal sphincter when delivering a primiparous lady