Endometriosis

A methodical gross examination should be undertaken in all births and the results incorporated in the patient’s record.

The Pathology of the Human Placenta

Background
Episiotomy is done to prevent severe perineal tears, but its routine use has been questioned. The relative effects of midline compared with midlateral episiotomy are unclear.

Objectives
The objective of this review was to assess the effects of restrictive use of episiotomy compared with routine episiotomy during vaginal birth.

Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2008).

Selection criteria
Randomized trials comparing restrictive use of episiotomy with routine use of episiotomy; restrictive use of mediolateral episiotomy versus routine mediolateral episiotomy; restrictive use of midline episiotomy versus routine midline episiotomy; and use of midline episiotomy versus mediolateral episiotomy.

Data collection and analysis
The two review authors independently assessed trial quality and extracted the data.

Main results
We included eight studies (5541 women). In the routine episiotomy group, 75.15% (2035/2708) of women had episiotomies, while the rate in the restrictive episiotomy group was 28.40% (776/2733). Compared with routine use, restrictive episiotomy resulted in less severe perineal trauma (relative risk (RR) 0.67, 95% confidence interval (CI) 0.49 to 0.91), less suturing (RR 0.71, 95% CI 0.61 to 0.81) and fewer healing complications (RR 0.69, 95% CI 0.56 to 0.85). Restrictive episiotomy was associated with more anterior perineal trauma (RR 1.84, 95% CI 1.61 to 2.10). There was no difference in severe vaginal/perineal trauma (RR 0.92, 95% CI 0.72 to 1.18); dyspareunia (RR 1.02, 95% CI 0.90 to 1.16); urinary incontinence (RR 0.98, 95% CI 0.79 to 1.20) or several pain measures. Results for restrictive versus routine mediolateral versus midline episiotomy were similar to the overall comparison.

Authors' conclusions
Restrictive episiotomy policies appear to have a number of benefits compared to policies based on routine episiotomy. There is less posterior perineal trauma, less suturing and fewer complications, no difference for most pain measures and severe vaginal or perineal trauma, but there was an increased risk of anterior perineal trauma with restrictive episiotomy.

/pdf/episiotomy-for-vaginal-birth-4mxfdb9j0o.pdf

Harold L. Gainey

Papers

Post-partum observation of pelvic tissue damage

Postpartum observation of pelvic tissue damage: further studies.

Noninvolution of the placental site: clinical and pathological studies.

Pseudotoxemic state associated with severe rh isoimmunization.

Submucous myoma in term pregnancy.