Clinical evaluation of early postpartum pain and healing outcomes after mediolateral versus lateral episiotomy

Abstract

Objective: To evaluate short-term perineal pain among primiparous women after mediolateral episiotomy (MLE) and lateral episiotomy (LE).

Methods: The prospective randomized study was conducted in the Czech Republic during 2010-2012. Consecutive primiparous women who gave birth at or after 37 weeks of pregnancy and had indications for an episiotomy were enrolled and randomly assigned to undergo MLE or LE. Patients were unaware of the episiotomy type performed. The primary outcomes were pain at 24 hours, 72 hours, and 10 days post partum, measured by a visual analog scale, verbal rating scale, interference with activities of daily living, and amount of analgesic use.

Results: The analysis included 266 women who underwent MLE and 297 women who underwent LE. Complete relief of pain was observed in 6 (2.3%) of 266 women after 24 hours, 21 (8.0%) of 264 after 72 hours, and 77 (29.1%) of 265 after 10 days in the MLE group, and in 11 (3.9%) of 285, 23 (7.7%) of 297, and 78 (26.4%) of 295 in the LE group, respectively (P=0.36). There were no significant differences in overall pain scores from any rating system or in the amount of analgesics used.

Conclusion: Incidence and extent of pain in the first 10 days after LE correspond to those after adequately performed MLE.

Keywords: Lateral episiotomy; Mediolateral episiotomy; Pain; Painful defecation; Visual analog scale; Wound healing.