Does episiotomy prevent perineal trauma and pelvic floor relaxation?

Title

Does episiotomy prevent perineal trauma and pelvic floor relaxation?

Creator

Klein MC; Gauthier RJ; Jorgensen SH; Robbins JM; Kaczorowski J; Johnson B; Corriveau M; Westreich R; Waghorn K; Gelfand MM

Publisher

The Online Journal Of Current Clinical Trials

Date

1992

Subject

Female; Humans; Pregnancy; Pain; Adult; Time Factors; RDF Project; Coitus; Episiotomy/adverse effects/methods; Labor Stage; Muscle Hypotonia/prevention & control; Parity; Pelvic Floor; Perineum/injuries; Postoperative; Rectum/injuries; Second; Urinary Incontinence/prevention & control; Wounds and Injuries/etiology/prevention & control

Description

OBJECTIVE: To compare the outcomes of the current practice of liberally or routinely employing episiotomy to prevent perineal tears and pelvic floor relaxation (control group) to a policy of restricting episiotomy use to specific fetal and maternal indications (experimental group). DESIGN: A randomized controlled trial (RCT). SETTING: Three university hospitals in Montreal. SUBJECTS: Seven hundred three low-risk women enrolled at 30 to 34 weeks of gestation were randomized late in labor to the designated trial arm, by parity, and followed up to 3 months postpartum. MAIN OUTCOME MEASURES: Antepartum and postpartum information on perineal trauma and pain, pelvic floor symptoms (urinary incontinence), and sexual activity was collected through the use of standard questionnaires; pelvic floor function was measured by electromyographic (EMG) perineometry. RESULTS: Restricting episiotomy use in primiparous women was associated with similar sutured perineal trauma to the liberal or routine approach. Multiparous women in the restricted episiotomy group more often gave birth with an intact perineum (31% compared with 19%, odds ratio (OR) = 1.85, 95% confidence interval (CI) = 1.09 to 3.16). All but one 3rd/4th-degree perineal tear was associated with median episiotomy (46 of 47 in primiparous women and 6 of 6 among multiparous women). No difference between trial groups was found in postpartum perineal pain, antepartum and 3-month postpartum EMG perineometry, and urinary and pelvic floor symptoms. CONCLUSIONS: We found no evidence that liberal or routine use of episiotomy prevents perineal trauma or pelvic floor relaxation. Virtually all severe perineal trauma was associated with median episiotomy. Restriction of episiotomy use among multiparous women resulted in significantly more intact perineums and less perineal suturing.
1992

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Type

Journal Article

Citation List Month

Backlog

Pages

[6019 words

Issue

65 paragraphs]

Citation

Klein MC; Gauthier RJ; Jorgensen SH; Robbins JM; Kaczorowski J; Johnson B; Corriveau M; Westreich R; Waghorn K; Gelfand MM, “Does episiotomy prevent perineal trauma and pelvic floor relaxation?,” Pediatric Palliative Care Library, accessed July 2, 2022, https://pedpalascnetlibrary.omeka.net/items/show/11975.

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