EPISIOTOMIES AND THE OCCURRENCE OF SEVERE PERINEAL LACERATIONS

Objective To investigate the relation between the use of mediolateral episiotomy and the occurrence of severe (third degree) perineal tears in hospital deliveries in the Netherlands. Design An observational stu dy. Subjects Data were derived from the Dutch National Obstetric Datab ase (LVR) of 1990, from which 43 309 spontaneous, occipito-anterior, v aginal deliveries of live, singleton infants were investigated. Interv ention Medio-lateral episiotomy. Main outcome measure The occurrence o f severe perineal tears. Results The severe tear rate was 1.4% in the total study group. Using multiple logistic regression to control for p ossible confounding variables, the use of mediolateral episiotomy was found to be associated with a more than fourfold decrease in risk of s evere lacerations (odds ratio 0.22, 95 % CI 0.17 to 0.29). Further, in a logistic model deliveries in hospitals with restrictive use of epis iotomy (< 11 %) were compared with those in hospitals with liberal use of episiotomy (> 50 %). Liberal use of episiotomy was not associated with a lower frequency of severe perineal tears. Conclusion Although a protective effect of mediolateral episiotomy on the occurrence of sev ere lacerations was found, liberal use of mediolateral episiotomy shou ld be discouraged on the basis of our findings.