Episiotomy: limitations, indications and benefits

Episiotomy is the most commonly performed surgical procedure in obstetrics. There are many purported benefits such as prevention of trauma to the pelv ic floor, prevention of severe perineal tears and third-degree and fourth-d egree lacerations,shortening of the second stage of labour, reduced compres sion to the foetal head and enlargement of the vaginal outlet. This belief resulted in various indications for episiotomy: perineal or vaginal tears p resumed to be imminent, prolonged second stage of labour in the case of foe tal distress, breech delivery and other foetal malpresentations (i.e. occip ut malpresentation), assisted delivery (vacuum and forceps extraction), and prophylactic use of episiotomy (routine episiotomy). However, there is little scientific evidence to support the ascribed benefi ts. There are only few indications far an episiotomy with proved benefit fo r mother or child. Liberal use of episiotomy does not decrease trauma to th e pelvic floor and its sequelae such as urinary incontinence, anal incontin ence or pelvic floor relaxation. Compared to spontaneous tears, episiotomy is not associated with improved w ound healing. Routine use of episiotomy, therefore, should be avoided;the i ndication for an episiotomy should be determined individually on a case-by- case basis.