title: Cohort study of maternal and neonatal morbidity in relation to use of episiotomy at instrumental vaginal delivery.
abstract: OBJECTIVE
  The aim of this study was to investigate the maternal and neonatal morbidity related to use of episiotomy for vacuum and forceps deliveries.
  
  
  METHODS
  Retrospective population-based cohort study.
  
  
  METHODS
  Dundee, Scotland.
  
  
  METHODS
  Two thousand one hundred and fifty three women who experienced an instrumental vaginal delivery between January 1998 and December 2002.
  
  
  METHODS
  Univariate and multivariate logistic regression analyses were performed comparing deliveries with and without the use of episiotomy.
  
  
  METHODS
  Extensive perineal tears (third and fourth degree) and shoulder dystocia.
  
  
  RESULTS
  Two hundred and forty-one (11%) of the 2153 women who underwent instrumental vaginal deliveries did not receive an episiotomy. Vacuum delivery was associated with less use of episiotomy compared with forceps (odds ratio 0.10, 95% CI 0.07-0.14). Extensive perineal tears were more likely with use of episiotomy (7.5%vs 2.5%, adjusted OR 2.92, 95% CI 1.27-6.72) as was neonatal trauma (6.0%vs 1.7%, adjusted OR 2.62, 95% CI 1.05-6.54). Use of episiotomy did not reduce the risk of shoulder dystocia (6.9%vs 4.6%, adjusted OR 1.43, 95% CI 0.74-2.76). The findings were similar for delivery by vacuum and forceps.
  
  
  CONCLUSIONS
  The use of episiotomy increased the risk of extensive perineal tears without a reduction in the risk of shoulder dystocia.
authors.affiliation: Ninewells Hospital and Medical School, Dundee, UK.
authors.forename: Refaat
authors.initials: R
authors.lastname: Youssef
authors.forename: Uma
authors.initials: U
authors.lastname: Ramalingam
authors.forename: Maureen
authors.initials: M
authors.lastname: Macleod
authors.forename: Deirdre J
authors.initials: DJ
authors.lastname: Murphy
mesh_terms: D015331:Cohort Studies; D004420:Dystocia / Q000517:prevention & control; D004841:Episiotomy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D007744:Obstetric Labor Complications / Q000209:etiology; D009772:Obstetrical Forceps / Q000706:statistics & numerical data; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D012307:Risk Factors; D012606:Scotland; D014620:Vacuum Extraction, Obstetrical / Q000706:statistics & numerical data*