title: Midline episiotomy and anal incontinence: retrospective cohort study.
abstract: OBJECTIVE
  To evaluate the relation between midline episiotomy and postpartum anal incontinence.
  
  
  METHODS
  Retrospective cohort study with three study arms and six months of follow up.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  Primiparous women who vaginally delivered a live full term, singleton baby between 1 August 1996 and 8 February 1997: 209 who received an episiotomy; 206 who did not receive an episiotomy but experienced a second, third, or fourth degree spontaneous perineal laceration; and 211 who experienced either no laceration or a first degree perineal laceration.
  
  
  METHODS
  Self reported faecal and flatus incontinence at three and six months postpartum.
  
  
  RESULTS
  Women who had episiotomies had a higher risk of faecal incontinence at three (odds ratio 5.5, 95% confidence interval 1.8 to 16.2) and six (3.7, 0.9 to 15.6) months postpartum compared with women with an intact perineum. Compared with women with a spontaneous laceration, episiotomy tripled the risk of faecal incontinence at three months (95% confidence interval 1.3 to 7.9) and six months (0.7 to 11.2) postpartum, and doubled the risk of flatus incontinence at three months (1.3 to 3.4) and six months (1.2 to 3.7) postpartum. A non-extending episiotomy (that is, second degree surgical incision) tripled the risk of faecal incontinence (1.1 to 9.0) and nearly doubled the risk of flatus incontinence (1.0 to 3.0) at three months postpartum compared with women who had a second degree spontaneous tear. The effect of episiotomy was independent of maternal age, infant birth weight, duration of second stage of labour, use of obstetric instrumentation during delivery, and complications of labour.
  
  
  CONCLUSIONS
  Midline episiotomy is not effective in protecting the perineum and sphincters during childbirth and may impair anal continence.
authors.affiliation: Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, United States. lbsignore@aol.com
authors.forename: L B
authors.initials: LB
authors.lastname: Signorello
authors.forename: B L
authors.initials: BL
authors.lastname: Harlow
authors.forename: A K
authors.initials: AK
authors.lastname: Chekos
authors.forename: J T
authors.initials: JT
authors.lastname: Repke
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004841:Episiotomy / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000209:etiology / Q000601:surgery; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome