Thanks, Leanne. Good reminder of why we don't go to hosp to have our
babies. Gloria
leanne wynne wrote:
Increasing Angle of Episiotomy Reduces Third-Degree Tear Risk
Reuters Health Information 2006. © 2006 Reuters Ltd.
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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.
--------------------------------------------------------------------------------
Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service Mob 0418 371862
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