Clinical evaluation of peripartum outcomes of mediolateral versus lateral episiotomy

Int J Gynaecol Obstet. 2014 Jan;124(1):72-6. doi: 10.1016/j.ijgo.2013.07.011. Epub 2013 Sep 25.

Abstract

Objective: To evaluate the incidence and extent of vaginal and perineal trauma among primiparous women after mediolateral and lateral episiotomy.

Methods: In a prospective randomized study at University Hospital Pilsen, Czech Republic, 790 consecutive primiparous women were enrolled between April 2010 and April 2012. Mediolateral episiotomy (MLE) followed an angle of at least 60° from the midline. Lateral episiotomy (LE) started 1-2 cm laterally from the midline and was directed toward the ischial tuberosity. A rectal examination was performed before episiotomy repair.

Results: MLE was performed for 390 women, and LE for 400. The groups did not differ in maternal or neonatal characteristics. No difference was found in incidence or extent of vaginal and perineal trauma; or in additional perineal (1.8% vs 1.5%, P=0.6) or vaginal (8.5% vs 10.6%, P=0.2) trauma continuing along the episiotomy incision. The incidence of anal sphincter injury did not differ between MLE and LE (1.5% vs 1.3%, P=0.7). MLE was associated with shorter repair times (P<0.05), less suturing material (P<0.05), and shorter distances from the anus (P<0.001).

Conclusion: Risk of additional vaginal and perineal trauma, and anal sphincter injury after adequately performed mediolateral episiotomy is relatively low and corresponds to that of lateral episiotomy.

Keywords: Blood loss; Lateral episiotomy; Mediolateral episiotomy; Obstetric anal sphincter injuries; Perineal trauma; Vaginal trauma.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anal Canal / injuries
  • Blood Loss, Surgical / statistics & numerical data
  • Episiotomy / adverse effects*
  • Episiotomy / methods*
  • Female
  • Humans
  • Operative Time
  • Perineum / injuries
  • Pregnancy
  • Vagina / injuries
  • Young Adult