title: Is the policy of restrictive episiotomy generalisable? A prospective observational study.
abstract: OBJECTIVE
  To assess whether the policy of restrictive episiotomy could be safely implemented in Chinese population, and whether perineal length was related to risk of perineal tear during spontaneous vaginal delivery.
  
  
  METHODS
  A prospective observational study was conducted between November 2007 and February 2008. A restrictive approach of episiotomy was implemented in those Chinese women who carried an uncomplicated singleton cephalic presenting pregnancy in labour. Perineal length (PL) was measured at three time points: (A) at early first stage of labour; (B) at the beginning of the second stage; (C) at crowning. Women with and without perineal tears were compared with reference to PL measured at different stages and its stretching performance (defined by the change in PL between different stages).
  
  
  RESULTS
  Among the 429 women recruited, mean PL at point A, B and C was 38.8 mm (+/-7.9), 49.4 mm (+/-8.1) and 59.4 mm (+/-9.4), respectively, which were similar to those reported in other countries. Episiotomy rate reduced from 73.3 to 26.8%. Among the non-episiotomy group, 13.7% had no perineal tear, 86.3% had minor (first or second degree) tears but none had major tears, whilst 3.5% and 0.9% of episiotomy group had minor and major tears, respectively. PL was not associated with the risk of perineal tear.
  
  
  CONCLUSIONS
  Restrictive episiotomy reduces the episiotomy rate without compromising the perineal safety. Chinese women's PL is not shorter than other races, or is predictive of perineal tears.
authors.affiliation: Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China SAR.
authors.forename: Chit Ying
authors.initials: CY
authors.lastname: Lai
authors.forename: Hiu Wah
authors.initials: HW
authors.lastname: Cheung
authors.forename: Terence Tzu
authors.initials: TT
authors.lastname: Hsi Lao
authors.forename: Tze Kin
authors.initials: TK
authors.lastname: Lau
authors.forename: Tak Yeung
authors.initials: TY
authors.lastname: Leung
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries / Q000601:surgery; D001724:Birth Weight / Q000502:physiology; D002681:China; D036861:Delivery, Obstetric / Q000379:methods; D004841:Episiotomy / Q000009:adverse effects / Q000331:legislation & jurisprudence* / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D022125:Lacerations / Q000601:surgery; D007744:Obstetric Labor Complications / Q000601:surgery; D010502:Perineum / Q000293:injuries / Q000601:surgery; D011247:Pregnancy; D011361:Professional Competence; D011446:Prospective Studies; D014621:Vagina / Q000293:injuries; D055815:Young Adult