Episiotomy, operative vaginal delivery, and significant perineal trauma innulliparous women

OBJECTIVES: The aim of this study was to determine whether choice of obstet ric instrument at operative vaginal delivery is associated with any differe nces in the rate of significant perineal trauma and whether this rate is mo dified by the use of episiotomy. STUDY DESIGN: The occurrence of significant perineal trauma among 323 conse cutive operative vaginal deliveries was evaluated according to type of inst rument used and performance of episiotomy. These findings were compared wit h spontaneous vaginal deliveries during the same period. RESULTS: Among forceps deliveries the use of episiotomy was not associated with a difference in the occurrence of significant perineal trauma (55% vs 46%; relative risk, 1.2; 95% confidence interval. 0.8-1.9). Among vacuum ex traction deliveries an increased rate of such trauma was noted when episiot omy was used (34.9% vs 9.4%; relative risk, 3.7; 95% confidence interval, 1 .2-11.2). There was no difference in the rate of significant perineal traum a according to type of forceps used. In a logistic regression analysis forc eps delivery with or without episiotomy was associated with an increase of >10-fold in the rate of significant perineal trauma with respect to vacuum extraction deliveries without episiotomy. CONCLUSIONS: Our data suggest that in forceps delivery neither the type of forceps nor episiotomy influences the risk of significant perineal trauma. When vacuum extraction delivery is performed,the use of episiotomy is assoc iated with a higher risk of significant perineal trauma.