Introduction and aim of the study: Episiotomy has proven to be a protective factor during operative vaginal delivery and restrictive use during normal vaginal delivery for developing an anal sphincter tear [
1
, 2
, 3
]. This study evaluates if an episiotomy also might reduce the risk of obtaining other pelvic floor injuries; i.e. levator avulsion (LA) and/or levator ballooning, and urogynecological complaints.Materials and methods: A prospective observational cohort study of 204 primiparous women with a spontaneous vaginal delivery between 2012 and 2015 being delivered in a general hospital in the Netherlands. 103 of these women had undergone an episiotomy. Validated urogynecological questionnaires and transperineal 3D/4D ultrasound were completed between 6 and 33 months after delivery. Statitistacal analysis was performed using univariate and multiple logistic regression analysis.
Results: LA was identified in 27 (22.8%) of the 103 women whom had undergone an episiotomy and in 23 (26.2%) of the 101 women who had not (p = 0.529). There was also no significant difference in levator ballooning between women with or without episiotomy (20 (19.4%) versus 23 (22.8%); p = 0.557) Oxytocine use was found to be a protective factor for LA (OR 0.48 (95% CI 0.234-0.990) p = 0.047). The duration of the second stage of labour increased the risk for LA (OR 1.01 (95% CI 1.001–1.028). Non occiput anterior fetal position increased the risk for ballooning and for pelvic floor injuries (OR 10.38 (95% CI 1.87–57.66) and OR 11.01 (95% CI 1.26–96.03). There were neither differences in urogynecological complaints between women with or without episiotomy nor between women with or without pelvic floor injuries.
Interpretation of results: Pelvic floor injury is related with a prolonged second stage of labor, but not with episiotomy.
Conclusions: Episiotomy has no influence in developing pelvic floor injuries or urogynecological complaints.
References
- Obstetric anal sphincter injuries: review of anatomical factors and modifiable second stage interventions.Int Urogynecol J. 2015 Dec; 26: 1725-1734
- Obstetric anal sphincter injuries after episiotomy: systematic review and meta-analysis.Int Urogynecol J. 2016 Feb 19;
- The effect of a mediolaterale episiotomy during operative vaginal delivery on the risk of developing obstetrical anal sphincter injuries.Am J Obstet Gynecol. 2012 May; 206: 404
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© 2017 Published by Elsevier Inc.
