Is there a benefit to episiotomy at spontaneous vaginal delivery? A natural experiment

• Published in: American journal of obstetrics and gynecology 1996-10, Vol.175 (4), p.897-901
• Main Authors: Bansal, Raj K., Tan, Winona M., Ecker, Jeffrey L., Bishop, Judith T., Kilpatrick, Sarah J.
• Format: Article
• Language: English
• Subjects: Episiotomy; Episiotomy - adverse effects; Episiotomy - statistics & numerical data; Evaluation Studies as Topic; Female; Fetal Macrosomia - complications; Humans; Parity; perineal lacerations; Perineum - injuries; Pregnancy; Regression Analysis; spontaneous vaginal delivery; Vagina - injuries; Wounds, Penetrating - epidemiology; Wounds, Penetrating - etiology
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/S0002-9378(96)80021-4

OBJECTIVE: Our purpose was to examine the association between maternal vaginal and perineal morbidity and episiotomy performed at spontaneous vaginal delivery. STUDY DESIGN: We obtained data from 17,483 consecutive spontaneous vaginal deliveries and compared the yearly rates of episiotomy, lacerations, and potential confounders with linear regression and stratified analyses. RESULTS: Between 1976 and 1994 the use of episiotomy fell significantly (86.8% to 10.4%, R2 = 0.92, p = 0.0001). This change was associated with a fall in the rate of third- and fourth-degree lacerations (9.0% to 4.2%, R2 = 0.59, p = 0.0001) and a rise in the rate of intact perinea (10.3% to 26.5%, R2 = 0.68, p = 0.0001) and vaginal lacerations (5.4% to 19.3%, R2 = 0.77, p = 0.0001). These associations held in separate analyses stratified by parity and birth weight, except for the subgroup of nulliparous women with macrosomic infants. CONCLUSION: At our institution a large reduction in the use of episiotomy in spontaneous vaginal deliveries was associated with a significant reduction in perineal trauma in all groups of women except for nulliparous women with macrosomic infants. (Am J Obstet Gynecol 1996;175:897-901.)