title: Episiotomies and the occurrence of severe perineal lacerations.
abstract: OBJECTIVE
  To investigate the relation between the use of mediolateral episiotomy and the occurrence of severe (third degree) perineal tears in hospital deliveries in the Netherlands.
  
  
  METHODS
  An observational study.
  
  
  METHODS
  Data were derived from the Dutch National Obstetric Database (LVR) of 1990, from which 43,309 spontaneous, occipito-anterior, vaginal deliveries of live, singleton infants were investigated.
  
  
  METHODS
  Medio-lateral episiotomy.
  
  
  METHODS
  The occurrence of severe perineal tears.
  
  
  RESULTS
  The severe tear rate was 1.4% in the total study group. Using multiple logistic regression to control for possible confounding variables, the use of mediolateral episiotomy was found to be associated with a more than fourfold decrease in risk of severe lacerations (odds ratio 0.22, 95% CI 0.17 to 0.29). Further, in a logistic model deliveries in hospitals with restrictive use of episiotomy (< 11%) were compared with those in hospitals with liberal use of episiotomy (> 50%). Liberal use of episiotomy was not associated with a lower frequency of severe perineal tears.
  
  
  CONCLUSIONS
  Although a protective effect of mediolateral episiotomy on the occurrence of severe lacerations was found, liberal use of mediolateral episiotomy should be discouraged on the basis of our findings.
authors: TNO Prevention and Health, Foundation for Perinatal Epidemiology, Leiden, The Netherlands.
authors: S
authors: S
authors: Anthony
authors: S E
authors: SE
authors: Buitendijk
authors: K T
authors: KT
authors: Zondervan
authors: E J
authors: EJ
authors: van Rijssel
authors: P H
authors: PH
authors: Verkerk
mesh_terms: D004841:Episiotomy / Q000379:methods; D005260:Female; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D016017:Odds Ratio; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors