Episiotomy: early maternal and neonatal outcomes of selective versus routine use

Abstract

Overview and aims: Episiotomy is one of the most common procedures in Obstetrics, despite actual scientific evidence does not support its routine practice. The aim of this study was to determine the impact of selective and routine practice of episiotomy in early maternal and neonatal outcomes.

Study design: An observational, transversal, descriptive and analytic study was conducted in two public Hospitals in no r - thern Portugal, with different policies for the practice of episiotomy: selective practice (Hospital A) and routine practice (Hospital B). Population: A non-random sampling of convenience of the whole puerperal women whose deliveries was performed in these hospitals during months of July and August 2011 was utilized. A total of 397 women was analyzed, 200 in selective group and 197 in routine group. Methods: Data was collected by consultation of medical records of the puerperal women. Comparison between hospitals was performed with the chi-square test. Results: The groups were similar for the obstetric history, demographic, biometric, pregnancy and labor characteristics. However, gestational age, weight and head circumference of newborns as well as instrumentation rate were significantly higher in selective group. Episiotomy was performed in 72.5% cases of selective group and in 88.8% of routine group (p=0.001). There was less perineal suturing (p=0.001) and a greater number of intact perineum in selective group (p=0.001), without differences in lacerations type or degree. The routine group presented more frequent early perineal complications and higher pain levels in the first postpartum day (p=0.001). No differences were found between groups in Apgar scores, neonatal trauma and Neonatal Intensive Care Unit admissions number. Conclusions: The selective use of episiotomy was associated with better early maternal outcomes, with no differences in neonatal morbidity. Thus, the routine practice of episiotomy showed no benefits.