[The impact of changing the approach of performing episiotomy on perineal trauma in primiparous: a comparison between two periods with different episiotomy rates].

BACKGROUND

The purpose of this study was to evaluate the impact of changing the approach of performing episiotomy on immediate delivery complications in primiparous women by comparing two periods of time with different episiotomy rates.

MATERIALS AND

METHODS

A retrospective population-based study comparing singleton vaginaL deliveries of nulliparous women for immediate delivery complications during two periods of time: 9192 women during 1994-1999 (period A) with episiotomy rates of 80%-90% and 11,150 women during 2002-2009 (period B) with episiotomy rates of 20%-30%.

RESULTS

The study included 20,342 vaginal deliveries. First and second degree perineal tears rate was significantly higher during period B than period A (37.5% vs. 5.8%, p < 0.00). Third degree perineal tears were four times more prevalent in period B than in period A [0.4% vs. 0.1%, p < 0.0001). First and second degree perineal tears rate was significantly higher in women not undergoing episiotomy in both periods. Multiple logistic regression analysis reveals that episiotomy is a significant predictor for first and second degree perineal tears (OR = 0.1, p < 0.001) but not for third degree perineal tears.

CONCLUSIONS

Since spontaneous first and second degree perineal tears entail no significant morbidity, it is better to manage uncomplicated deLiveries in primiparous women without the use of episiotomy.