Midline episiotomies: more harm than good?

Article Abstract:

An episiotomy is a surgical procedure performed during vaginal childbirth that enlarges the opening of the vagina to ease infant delivery. Although the procedure is performed routinely (in 60 percent of all vaginal deliveries in the US), there is no evidence that a straight-line (midline) episiotomy is more advantageous than the ragged mediolateral (in the middle and to one side) type or no episiotomy at all. The association between midline episiotomies and severe tears classified as either third degree or fourth degree (the latter being a tear that includes the anal sphincter) were studied among 24,114 women. The severe tear rate among women delivering for the first time was 8.3 percent, while in women who had had a previous delivery it was 1.5 percent. Women who received incisions that were midline were 50 times more likely to end up with a severe laceration and women who had a mediolateral incision were eight times more likely to have a severe laceration than women having no episiotomy at all. Severe lacerations were more likely to occur if the infant was large, forceps were used to assist the delivery, there was an unusual fetal position, the woman had a small pelvic diameter or the woman was lightweight. When confounding risk factors were removed, a mediolateral episiotomy was associated with a 2.5-fold reduction in risk of severe laceration in first-time delivering women and a 2.4-fold increased risk in women having previous childbirth over no episiotomy at all. First-time delivering women were 4.2 times more likely and women with childbirth experience were 12.8 times more likely to have a laceration of any kind than women who did not undergo episiotomy. It is concluded that midline episiotomies do not prevent injury to the perineal are (area between the vagina and anus). Clinical trials that examine the effects of usual versus conservative use of midline episiotomies are suggested. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Episiotomy, Surgery, Unnecessary, Unnecessary surgery, Labor, Complicated, Labor complications

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Keeping Research Subjects Out of Harm's Way

Article Abstract:

Doctors and hospital administrators must do all they can to ensure that people participating in medical research are protected from exploitation. These patients are providing a valuable public service by volunteering to serve as a research subject. Since many research trials are done in hospitals, the hospital's IRB is the best way to protect patients. The IRB office could maintain a list of contacts for questions about medical research as well as providing any documentation needed.

Editorial, Ethical aspects, Human experimentation in medicine, Human medical experimentation

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Taxing harm for health

Article Abstract:

The tobacco levy insures that Victoria, Australia's general health budget is not compromised. VicHealth sponsors sports and cultural event while promoting the benefits of nonsmoking and a healthy lifestyle. Public support for the tax was helped by a strong tobacco-control movement already in place.

Australia, Taxation, Finance, Social policy, Health promotion, Tobacco industry, Tobacco, Victoria

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