New Guidelines Call for Restricted Use of Episiotomies
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NEW YORK (Reuters Health) Mar 31 - Episiotomies should not be performed on a
routine basis, but there are situations where the procedure is indicated,
according to new practice guidelines by The American College of
Obstetricians and Gynecologists (ACOG).
Episiotomy has become one of the most commonly performed obstetrical
procedures: roughly a third of women with a vaginal birth in 2000 had an
episiotomy. The purported benefits include a reduced risk of perineal trauma
and incontinence for the mother and a shortened second stage of labor for
the fetus. However, data actually supporting these outcomes is lacking.
In reviewing the literature on episiotomies, Dr. John T. Repke and
colleagues, from ACOG, found that the procedure generally did not make
labor, delivery, and recovery easier for the mother. Moreover, episiotomy is
associated with important and, probably underestimated, risks, such as
extension into a third- or fourth-degree tear, anal sphincter dysfunction,
and dyspareunia.
Still, the guidelines, which appear in the April issue of Obstetrics &
Gynecology, note there are situations where episiotomy may be appropriate,
such as to prevent a severe maternal laceration or to expedite a difficult
delivery.
Based on "good and consistent" scientific evidence (level A), the
guidelines:
--Recommend restricted, rather than routine, use of episiotomy.
--Note a lower risk of anal sphincter injury with mediolateral episiotomy
versus median episiotomy.
Based on "limited or inconsistent" scientific evidence (level B), the
guidelines:
--Suggest that mediolateral episiotomy may be preferably to the median
approach in selected cases.
--Emphasize that routine episiotomy does not prevent incontinence related to
pelvic floor damage.
"In the case of episiotomy, as with all medical and surgical therapies, we
need to continually evaluate what we do and make appropriate changes based
on the best and most current evidence available," Dr. Repke said in a
statement. "We should avoid the pitfall of letting anything in medicine
become 'routine' and therefore, outside the realm of review and critical
analysis."
Obstet Gynecol 2006;107:957-960.
Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service Mob 0418 371862
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