cut begins from the posterior fourchette vertically to the perineum, and it scratches to half the thickness of the perineum.
Yes: Median episiotomy was associated with an increased rate of 3rd- and 4th-degree perineal laceration in both nulliparous and multiparous women, and mediolateral episiotomy was linked to increased rates of postpartum hemorrhage and analgesia use in this systematic review and meta-analysis.
The investigators found that US and Canadian studies reported using mainly median episiotomy, whereas European, Scandinavian, and Australian studies used mainly mediolateral episiotomy.
Although the use of median episiotomy
increased the risk of OASIS, [sup] the results of the various studies on the effect of mediolateral episiotomy causing OASIS were conflicting.
Those who had an uncomplicated median episiotomy
or a second-degree perineal tear were randomized to sutures made with the three materials; 66 to chromic catgut, 60 to standard polyglactin 910, and 66 to fast-absorbing polyglactin 910.
An increased risk of severe perineal lacerations (third- and fourth-degree tears) has been reported in women who sustained such lacerations at their previous delivery in studies by Payne and colleagues (unadjusted OR=3.4; 95% CI, 1.8-6.4) and by Peleg and coworkers (OR=2.5; 95% CI, 1.8-3.4). In these studies, many women gave birth with a median episiotomy, a known risk factor for severe perineal tears.
In a previous study we reported a 3-fold increase of third- and fourth-degree perineal tears associated with median episiotomy in primiparous women.
The final stimulus for our research occurred with the publication of the first large, well-conducted, midwifery-based RCT in England, which showed no benefit from a policy of routinely using mediolateral episiotomy. We observed that the results of this trial were easily rejected in North America, where physicians normally attend birth, and the usual technique, except where the British influence is strong, is a median episiotomy
. Since previous research had shown that the mediolateral incision was more painful than the median, we felt justified in studying median episiotomy
, which is usually practiced by North American obstetricians and family physicians.
Barbieri's recommendation to stop performing median episiotomy
. Although I avoid liberal use of episiotomy, I sometimes perform it in challenging vaginal deliveries.
Complications--especially OASIS--are more common with median episiotomy
, (3,6,7) which involves a vertical midline incision from the posterior fourchette toward the rectum.
I understand that he has concluded that the benefits of median episiotomy
are superior to mediolateral episiotomy, and I encourage him to continue performing median episiotomy
Many studies have reported that a median episiotomy
is associated with a higher rate of third- and fourth-degree lacerations than either 1) deliveries without an episiotomy or 2) deliveries with a mediolateral episiotomy.