The role of episiotomy in prevention of genital lacerations during vaginal deliveries--results from two European centers.
OBJECTIVE
There is an ongoing debate regarding the routine versus restrictive use of episiotomy The study aim was to investigate if episiotomy during vaginal deliveries can reduce both, the number and severity of genital lacerations.


METHODS
The study included all women who gave vaginal birth at AOU. "G. Martino" Messina (n=382) and the Clinic for Ob/Gyn Clinical Center of Serbia, Belgrade (n=4227) during 2011. Lacerations during birth were recorded and divided according to location and severity Women with lacerations were subdivided into two groups: with or without mediolateral episiotomy We assessed potential risk factors for laceration: maternal age, parity use of labor stimulants and epidural analgesia, participation in antenatal classes, fetal presentation, neonatal birth weight, and duration of the second stage of labor.


RESULTS
Older women had higher grade perineum or combined lacerations. Children with higher birth weight in occipito-posterior presentation caused higher grade lacerations. Performance of episiotomy was connected with fewer perineum and labial lacerations. There were no differences in laceration grade between patients with and without episiotomy Assessed parameters proved to be good discriminating factors between lacerations sites. According to logistic regression, laceration site was the most important risk factor for laceration grade. Combined lacerations had the highest grade.


CONCLUSIONS
Episiotomy can significantly reduce the number of genital lacerations, but it does not influence laceration grade. Advanced maternal age, higher parity occipitoposterior presentation and fetal macrosomia can cause lacerations during vaginal birth. Therefore, we suggest analysis of maternal and fetal factors to prevent widespread genital lacerations.
Antonio Simone
AS
Laganà
Milan
M
Terzic
Jelena
J
Dotlic
Emanuele
E
Sturlese
Vittorio
V
Palmara
Giovanni
G
Retto
Dusica
D
Kocijancic
D004841:Episiotomy / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007558:Italy; D022125:Lacerations / Q000453:epidemiology / Q000517:prevention & control*; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000517:prevention & control*; D018743:Perinatal Care / Q000379:methods; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D012307:Risk Factors; D055771:Serbia; D055815:Young Adult