[Episiotomy as a risk factor for early perineal trauma].
OBJECTIVE
To assess the association between medio-lateral episiotomy and early perineal trauma.


METHODS
A prospective observational cohort study of 667 consecutive vaginal deliveries was conducted over a 10-week period. On the day following delivery, all women were examined for the extent of early perineal trauma (swelling, oedema, haematoma), in addition to the episiotomy or lacerations. The demographic and clinical variables (age, parity, gestational age, birthweight, length of second stage, operative delivery, epidural, seniority of the obstetrical provider, episiotomy) and the post-partum treatment given for the perineum were retrieved from the hospital records.


RESULTS
The overall episiotomy rate was 37.6%. Significant early perineal trauma was found in 9.9% of the women, more so in the episiotomy group (17.1% vs 5.5%, p < 0.001). In the episiotomy group, a larger number of women received more than routine treatment for the perineum (6.4% vs 2.9%, p < 0.05). Episiotomy was found to be the major independent predictor for perineal trauma (OR: 4.5, 95% CI: 2.4-8.5, p < 0.001), followed by epidural analgesia (OR: 2.4, CI: 1.3-4.3, p < 0.05) and birth weight >3700 g (OR: 2.1, CI: 1.1-4.1, p < 0.05).


CONCLUSIONS
Episiotomy does not prevent immediate postpartum perineal trauma; rather, it is a major independent risk factor associated with significant early perineal trauma.
Departmentsof Obstetrics and Gynecology, Rambam Medical Center, Israel. l_lior@rambam.health.gov.il
Lior
L
Lowenstein
Laila
L
Haddad
Joseph
J
Itskovitz-Eldor
Edmond
E
Sabo
Peter
P
Jakobi
D000328:Adult; D001724:Birth Weight; D004841:Episiotomy / Q000009:adverse effects*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D012307:Risk Factors; D014947:Wounds and Injuries / Q000453:epidemiology*