Episiotomy, a surgical cut made in the perineum during childbirth, has been long debated in obstetrics. A new study explores its potential to reduce obstetric anal sphincter injury in nulliparous women undergoing vacuum-assisted delivery.
According to lead researcher Dr. Sandra Bergendahl, “We aimed to assess whether lateral episiotomy could effectively reduce the incidence of these severe injuries during assisted deliveries.”
The trial spanned across eight hospitals in Sweden and involved 717 women who were randomly assigned to either undergo lateral episiotomy or no episiotomy. The results were significant: only 6% of the women in the episiotomy group sustained obstetric anal sphincter injuries, compared to 13% in the no-episiotomy group.
Procedure and Methodology
The lateral episiotomy performed was standardized. The incision started 1-3 cm from the posterior fourchette at a 60° angle. Dr. Bergendahl emphasizes, “Precision in the incision angle and length was crucial to ensure uniformity across all study sites.” The procedure was followed by a comprehensive analysis of birth outcomes and postpartum recovery.
Dr. Maria Jonsson, another contributor to the study, added, “We were particularly focused on minimizing the risk of long-term complications like incontinence, which can deeply affect a woman’s quality of life.”
Safety and Side Effects
Despite the positive impact on sphincter injury reduction, the study found that wound infections and dehiscence were more common in the episiotomy group. “We observed a higher number of infections, but these were generally manageable,” said Dr. Sophia Brismar Wendel. The researchers are careful to highlight that while the reduction in sphincter injury is significant, the decision to perform an episiotomy should be individualized.
The trial also noted no substantial differences in postpartum pain, blood loss, or neonatal outcomes between the two groups. This suggests that while episiotomy can reduce specific injuries, it does not increase general discomfort or risks for the mother and baby.
Clinical Implications
This research provides solid evidence supporting lateral episiotomy for women requiring vacuum-assisted delivery. It opens the door for revising clinical guidelines, particularly in cases where the risk of obstetric injury is high. Dr. Bergendahl concludes, “Lateral episiotomy can now be considered a viable option to minimize serious injuries, especially for first-time mothers.”
The researchers hope that this evidence will encourage obstetricians to consider lateral episiotomy more frequently. “We are confident that this intervention, when used appropriately, can greatly improve maternal health outcomes,” said Dr. Helena Kopp Kallner.
Citation:
Bergendahl S, Jonsson M, Hesselman S, et al. Lateral episiotomy or no episiotomy in vacuum assisted delivery in nulliparous women (EVA): multicentre, open label, randomised controlled trial. BMJ. 2024;385. doi:10.1136/bmj-2023-079014.
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