Does mediolateral episiotomy reduce the risk of anal sphincter injury in operative vaginal delivery?
Yes. This retrospective cohort study found a sixfold reduction in the odds of obstetric anal sphincter injuries in women undergoing operative vaginal delivery when mediolateral episiotomy was performed, compared with no mediolateral episiotomy (adjusted odds ratio, 0.17; 95% confidence interval, 0.12–0.24).
de Vogel J, der Leeuw-van Beek A, Gietelink D, et al. The effect of mediolateral episiotomy during operative vaginal delivery on the risk of developing obstetrical anal sphincter injuries. Am J Obstet Gynecol. 2012;206(5):404.e1–e5.
In this study, use of median episiotomy was an exclusion, mostly likely because it is rarely performed in Europe.
While the battle over “to cut or not to cut” continues to rage, one fact is clear: median episiotomy should be abandoned. If you are going to perform episiotomy, make it mediolateral. According to this report, accoucheurs should consider cutting a mediolateral episiotomy for perineal protection each time they perform operative vaginal delivery.
ERROL R. NORWITZ, MD, PHD
After reading this article, and Dr. Barbieri’s April Editorial, we want to know if these articles have changed your practice. If you were faced with a difficult vaginal delivery, would you use a median or mediolateral episiotomy incision? Why?
We want to hear from you! Tell us what you think.
