Friday, January 15, 2010

Lateral episiotomy protects from obstetric anal sphincter rupture only with the first child

Tearing through the perineal tissue (from the vagina to anus) during labor is a serious complication of childbirth and even if repaired can lead to fecal incontinence. Some studies have shown that risk factors for anal sphincter rupture during delivery include vacuum assisted delivery, forceps delivery, high birth weight, and prolonged 2nd stage of delivery, and midline (straight downward) episiotomy. Some reports don’t see a difference between routine use of episiotomy and very restrictive use of it in terms of anal rupture.

A recent HUGE study of over 500,000 women from Finland looked at risk factors for anal rupture during delivery and whether episiotomy had any bearing on it. It was found that episiotomy decreased the likelihood of anal rupture only in women delivery their first child, but not for any subsequent delivery. The strongest risk factors for anal rupture in first time births was forceps delivery, birth weight over 4 kg (approximately 9 lbs), vacuum assisted delivery, and prolonged 2nd stage delivery), reinforcing previously held concepts, which were also risk factors for women delivering their second child or more. Episiotomy appeared to be protective only in vacuum assisted delivery in women delivering their first child, but nothing else. Ultimately, the study concludes that episiotomy should be used sparingly as it takes nearly 900 episiotomies to spare one anal rupture. Cutting sideways away from the anus appears to be protective only in first time deliveries using vaccum.

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