Episiotomies and the occurrence of severe perineal lacerations

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Abstract
Objective To investigate the relation between the use of mediolateral episiotomy and the occurrence of severe (third degree) perineal tears in hospital deliveries in the Netherlands.Design An observational study.Subject Data were derived from the Dutch National Obstetric Database (LVR) of 1990, from which 43 309 spontaneous, occipito‐anterior, vaginal deliveries of live, singleton infants were investigated.Intervention Medio‐lateral episiotomy.Main outcome measure The occurrence of severe perineal tears.Results The severe tear rate was 1.4% in the total study group. Using multiple logistic regression to control for possible confounding variables, the use of mediolateral episiotomy was found to be associated with a more than fourfold decrease in risk of severe lacerations (odds ratio 0.22, 95% CI 0.17 to 0.29). Further, in a logistic model deliveries in hospitals with restrictive use of episiotomy (< 11%) were compared with those in hospitals with liberal use of episiotomy (≥ 50%). Liberal use of episiotomy was not associated with a lower frequency of severe perineal tears.Conclusion Although a protective effect of mediolateral episiotomy on the occurrence of severe lacerations was found, liberal use of mediolateral episiotomy should be discouraged on the basis of our findings.