Tertiary level fissures are frequently seen in interventional deliveries with midline episiotomy
. Uncontrolled fissures are seen less after medio-lateral episiotomy procedures.
Thirty-three (13.8%) women sustained OASIS of which 10 (10.1%) were identified in the RMLE-lateral group, 8 (16%) in the midline episiotomy
group, and 15 (16.5%) in the unclassified episiotomy group.
Reinforcing the importance of avoiding a midline episiotomy
, the "A" of passages stands for "aiming" lateral when an episiotomy is needed.
Risk factors for OASIS include forceps delivery (odds ratio [OR], 5.50), vacuum-assisted delivery (OR, 3.98), and midline episiotomy
Selective vs routine midline episiotomy
for the prevention of third or fourth-degree lacerations in nulliparous women.
Another study14 reported that among the spontaneous deliveries, third-degree tears were suffered by 6% without episiotomy, 11% with mediolateral episiotomy, and 20% with midline episiotomy
. The first randomized controlled trial published was from Dublin.15 "None of the patients delivering without having had an episiotomy during either the study or the preceding six months sustained a third-degree tear." The use of midline episiotomy
has consistently been found to be the strongest risk factor for a subsequent severe tear, even after controlling for confounding variables.
When midline episiotomy
was performed during instrument delivery, the risk of obstetric anal sphincter injury approximately doubled again, such that, in one study, forceps delivery with episiotomy caused a 25-fold increase in obstetric anal sphincter injury.
Limited evidence suggested that women who had a midline episiotomy
, which is more common in the United States, began intercourse significantly earlier after giving birth, but had a significantly greater probability of anal sphincter injuries than women who had a mediolateral episiotomy
Median or midline episiotomy
is popular in the US and the mediolateral in India and most of the Asian countries.
When I do, I opt for a midline episiotomy
rather than a mediolateral one.
Studies have demonstrated that midline episiotomy
carries a high risk of severe perineal lacerations than no episiotomy.14-16 As in this study, mediolateral episiotomy demonstratesd very high rate of perineal tears.