Increasing Angle of Episiotomy Reduces Third-Degree Tear Risk
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NEW YORK (Reuters Health) Mar 16 - The larger the angle of episiotomy, the
lower the risk of anal sphincter injury, a new study shows.
Injury to the anal sphincter due to a third-degree perineal tear during
vaginal delivery is the leading cause of fecal incontinence in healthy
women, Dr. Colm O'Herlihy of University College Dublin and colleagues note.
While the risk of third-degree tear is lower with mediolateral episiotomy
compared with midline episiotomy, they add, it remains unclear what effect
the angle of incision has on injury risk.
To investigate, the researchers looked at 100 primiparous women, all of whom
had right mediolateral episiotomy. Fifty-four of the women sustained
third-degree tears, while the rest did not and served as the control group.
All were evaluated three months after delivery.
The mean episiotomy angle in the cases was 30 degrees, compared with 38
degrees for controls. Nearly 10% of women with an angle of episiotomy below
25 degrees had third-degree tears, compared with 0.05% of women with an
episiotomy angle above 45 degrees. With every 6.3-degree increase in angle
size, the relative risk of third-degree tear was reduced by 50%.
Women with third-degree tears were not significantly more likely to report
problems with fecal incontinence, the researchers note. "Nonetheless, a
range of continence scores was seen in both groups, indicating that
continence compromise can occur postnatally, regardless of mode of delivery
or presence or absence of anal sphincter injury," they add. "Therefore, it
remains important to question and advise women on this problem in the
postnatal period."
They conclude: "If right mediolateral episiotomy is indicated, the angle of
this should be as large as possible in order to reduce the incidence, and
thus the potential sequelae, of obstetric anal sphincter injury."
BJOG 2006;113:190-194.
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Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service Mob 0418 371862
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