Episiotomy increases perineal laceration length in primiparous women

Article Abstract:

An episiotomy is clearly linked to perineal laceration in women during delivery. In a study of 80 pregnant women, six of the 27 women who had an episiotomy developed a perineal laceration but none of the 35 women who did not have an episiotomy did. The perineum is the area between the vagina and the rectum.

Complications

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Risk factors for third-degree and fourth degree perineal lacerations in forceps and vacuum deliveries

Article Abstract:

It is not uncommon for the area between a pregnant woman's anus and vagina (perineum) to tear during delivery. In some cases, the sphincter muscle surrounding the anus becomes disrupted (third and fourth degree laceration), causing incontinence of feces and gas and pain that can continue for years after the delivery. Third- and fourth-degree lacerations that include the lining of the rectum occur more often in women who are delivering for the first time or when a large fetus is being delivered vaginally. The risk factors for third- and fourth-degree lacerations for deliveries that were assisted by forceps and vacuum extraction are reported. Vacuum extraction or forceps were used in 2,832 deliveries. There were 555 third-degree tears (19.5 percent) and 296 fourth-degree tears (10.5 percent) reported. Women who had a midline episiotomy and first-time deliveries carried the highest relative risk for third- and fourth-degree lacerations (7.81 and 3.56 times, respectively). Other risk factors included arrest of labor during the second stage; fetal position with the face up and positioned high in the birth canal; maternal position flat on the back with legs straddled; the use of forceps; use of local anesthesia and Asian race. This was independent of birth weight, training of delivery attendant, age of the fetus, abnormal first-stage of labor and other factors. First-time deliveries are more prone to tears because the tissue in the perineal area is not elastic. An atypical position of the fetus may also prevent the tissue from being stretched adequately. Asian women tend to have short perineal areas, increasing the chances of tearing. Although these factors are difficult to control, other risk factors such as midline episiotomy, forceps delivery and local anesthesia can be replaced in turn by a jagged episiotomy, vacuum extraction and conduction anesthesia. Delivery in a birthing chair may also help prevent third- and fourth-degree lacerations. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Physiological aspects, Fetal presentation, Labor, Complicated, Labor complications, Parity

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Episiotomy, operative vaginal delivery, and significant perineal trauma in nulliparous women

Article Abstract:

During operative vaginal deliveries, an episiotomy only damages the perineum when it is done in conjunction with vacuum extraction. Operative vaginal deliveries are those that require forceps or vacuum extraction to help deliver the baby.

Obstetrical extraction

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