Iffat Javed, Tabassum Shoaib, Shereen Bhutta.
Liberal versus restricted use of Episiotomy in Primigravida
J Surg Pak Sep 2007;12(3):106-9.
Jinnah Postgraduate Medical Center Karachi

Objectives: To compare maternal and fetal outcome in primigravida delivering with or without episiotomy. Study Design: Randomized controlled study. Place & Duration of study: Department of Obstetrics & Gynaecology at Jinnah Postgraduate Medical Center in 2006. Patients & Methods: Three hundred primigravida with singleton spontaneous vertex deliveries were included. They were divided into two groups: A – in whom episiotomy was done and group B with no episiotomy. Extent of perineal injury, blood loss, the number of sutures used and time required for suturing the episiotomy or tear were noted. After two months patients were followed up in out patient department to assess the frequency of any perineal infection, urinary retention, constipation and dyspareunia. Results were compiled in a tabular form and analyzed. Results: In patients, who did not undergo episiotomy, 55 women had intact perineum, 54 had first degree tear and 41 second degree tear. Average weight of baby was 2.84 kg, average blood loss was 6.56 ml, perineal wound was 0.88 cm deep, 0.87 sutures and 4.90 minutes were needed to repair the tears in study group (B) compared to 3.05 kg, 18.21ml, 2.31cm deep, 2.15 sutures and 13.31 minutes in control group. Urinary retention occurred in 1 patient (0.9%), constipation in 8 (7.7%), infection in 1 (0.97%) dyspareunia in 6 (5.8%) patients in study group as compared to 3 (2.3%),17 (13.2%), 4 (3.1%) and 29 (22.4%) in control group (A) respectively. Conclusions: The study revealed a significant reduction in terms of perineal injury blood loss, material and time taken to suture the tears during delivery in patients with restricted use of episiotomy. In addition there was a significant reduction in constipation and dyspareunia during puerperium.

Category: Obstetrics and Gynecology
Keywords: Primigravida. Episiotomy. Labor. Pregnancy.

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