Episiotomies and the occurrence of severe perineal lacerations.
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.
Anthony
S
S
TNO Prevention and Health, Foundation for Perinatal Epidemiology, Leiden, The Netherlands.
Buitendijk
S E
SE
Zondervan
K T
KT
van Rijssel
E J
EJ
Verkerk
P H
PH
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