Association between median episiotomy and severe perineal lacerations in primiparous women.
OBJECTIVE
To evaluate the association between median episiotomy and severe (third- and fourth-degree) perineal lacerations in primiparous women.


METHODS
Retrospective cohort study.


METHODS
University-affiliated hospital providing secondary obstetric care in Quebec City.


METHODS
A total of 6522 primiparous women who gave birth vaginally to a single live baby in cephalic position between 1985 and 1993.


METHODS
Incidence of third- and fourth-degree perineal lacerations.


RESULTS
Median episiotomy was performed in 4390 women (67.3%). A total of 1002 women (15.4%) had a third- or fourth-degree laceration. The frequency of severe perineal lacerations was 20.6% with episiotomy and 4.5% without episiotomy (relative risk [RR] 4.58, 95% confidence interval [CI] 3.74-5.62). This association persisted after adjustment by stratified analysis for type of delivery and birth weight (RR 3.03, 95% CI 2.52-3.63) and by logistic regression for type of delivery, birth weight, epidural analgesia, shoulder dystocia, baby's head circumference, experience of the physician and year of delivery (odds ratio 3.58, 95% CI 2.84-4.50).


CONCLUSIONS
Median episiotomy is strongly associated with third- and fourth-degree perineal lacerations in primiparous women. Reducing the use of this procedure could decrease the occurrence of severe perineal tears.
Labrecque
M
M
Department of Family Medicine, Laval University, Quebec. michel.labrecque@mfa.ulaval.ca
Baillargeon
L
L
Dallaire
M
M
Tremblay
A
A
Pinault
J J
JJ
Gingras
S
S
D000328:Adult; D015331:Cohort Studies; D016001:Confidence Intervals; D004841:Episiotomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010298:Parity; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D012189:Retrospective Studies; D018570:Risk Assessment; D012421:Rupture