[Episiotomy and prevention of perineal and pelvic floor injuries].
OBJECTIVE
The objective of this review was to assess the efficacy of episiotomy to prevent severe perineal tears, urinary incontinence, faecal incontinence and genital prolapse.


METHODS
A systematic review on Medline database was performed between 1980 and 2005. One hundred seventy seven articles were selected. Trial quality was assessed on the following parameters: design (prospective, randomized, meta-analysis), sample size (>50) and relevant results. Finally, 43 articles were analysed.


RESULTS
The routine use of episiotomy did not prevent severe perineal tears. It decreased the risk of moderate anterior perineal lacerations. The risk of severe perineal tears during episiotomy increased in the following circumstances: primiparity, Asian women, perineal length<or=3cm, forceps or vacuum-assisted deliveries and macrosomia. Relevant studies were consistent in demonstrating no benefit for routine episiotomy to prevent urinary or faecal incontinence or pelvic floor relaxation, even if there is a lack of data concerning long-term effects on pelvic floor support.


CONCLUSIONS
The routine use of episiotomy to prevent severe perineal tears, urinary incontinence, faecal incontinence and genital prolapse should be abandoned.
Service de Gynécologie-Obstétrique, Hôpital Carémeau, place du Professeur-Robert-Debré, 30900 Nîmes Cedex 9. renaud.detayrac@chu-nimes.fr
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D000328:Adult; D004841:Episiotomy / Q000009:adverse effects / Q000379:methods; D005242:Fecal Incontinence / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D009123:Muscle Hypotonia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D010298:Parity; D017773:Pelvic Floor / Q000293:injuries*; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D012007:Rectum / Q000293:injuries; D014549:Urinary Incontinence / Q000209:etiology / Q000517:prevention & control; D014596:Uterine Prolapse / Q000209:etiology / Q000517:prevention & control; D014947:Wounds and Injuries / Q000209:etiology / Q000517:prevention & control