[Episiotomy and prevention of perineal and pelvic floor injuries]

Abstract

Objectives: The objective of this review was to assess the efficacy of episiotomy to prevent severe perineal tears, urinary incontinence, faecal incontinence and genital prolapse.

Material and methods: A systematic review on Medline database was performed between 1980 and 2005. One hundred seventy seven articles were selected. Trial quality was assessed on the following parameters: design (prospective, randomized, meta-analysis), sample size (>50) and relevant results. Finally, 43 articles were analysed.

Results: The routine use of episiotomy did not prevent severe perineal tears. It decreased the risk of moderate anterior perineal lacerations. The risk of severe perineal tears during episiotomy increased in the following circumstances: primiparity, Asian women, perineal length<or=3cm, forceps or vacuum-assisted deliveries and macrosomia. Relevant studies were consistent in demonstrating no benefit for routine episiotomy to prevent urinary or faecal incontinence or pelvic floor relaxation, even if there is a lack of data concerning long-term effects on pelvic floor support.

Conclusion: The routine use of episiotomy to prevent severe perineal tears, urinary incontinence, faecal incontinence and genital prolapse should be abandoned.