Approach to episiotomy
- Lori R Berkowitz, MD
Lori R Berkowitz, MD
- Assistant Professor
- Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Caroline E Foust-Wright, MD, MBA
Caroline E Foust-Wright, MD, MBA
- Assistant Professor of Urology/Obstetrics and Gynecology
- Tufts School of Medicine
Episiotomy is performed to enlarge the birth outlet and facilitate delivery of the fetus. Routine use of episiotomy has fallen out of favor based on evidence of increased complications with use. Episiotomy is now performed on an individualized basis. Episiotomy is considered when the clinical circumstances place the patient at high risk of a third or fourth degree laceration or when the fetal heart tracing is of concern and hastening vaginal delivery is warranted. Mediolateral episiotomy is associated with a lower risk of third and fourth degree laceration than a median episiotomy.
This topic will review the indications, risks, benefits, and procedure for episiotomy. The repair of episiotomy and obstetric anal sphincter laceration are presented separately.
Episiotomy is the surgical enlargement of the posterior aspect of the vagina by an incision to the perineum during the last part of the second stage of labor . The incision is performed with scissors or scalpel and is typically midline (median) or mediolateral in location. (See 'Procedures and selection' below.)
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- PREVALENCE AND RISK FACTORS
- ADVANTAGES OF RESTRICTED USE OF EPISIOTOMY
- ADVERSE OUTCOMES OF EPISIOTOMY
- WHEN TO CONSIDER EPISIOTOMY
- PROCEDURES AND SELECTION
- Mediolateral versus median (midline) episiotomy
- Median (midline)
- J incision
- PERFORMING EPISIOTOMY
- Patient education and consent
- Anesthesia options
- Delivery and repair
- IMPACT ON FUTURE DELIVERIES
- SUMMARY AND RECOMMENDATIONS