[Review of the literature on advantages and disadvantages: episiotomy: only limited protection against ruptures--time for a revision?].

A review of the literature on the pros and cons of episiotomy suggests that it should be used restrictively. Although there is a general agreement that episiotomy is protective against anterior perineal tears, no evidence has been found to support the belief that it is protective against anal sphincter muscle tears, pelvic muscle damage or urinary incontinence in the parturient or intracranial haemorrhage or intrapartum asphyxia in the newborn. Women undergoing episiotomy are characterised by greater blood loss in conjunction with delivery, and there is a risk of improper wound healing and increased pain during the early puerperium. The prevalence of episiotomy in Sweden has been declining over the past 20 years, and is now approximately five per cent among multiparae and fifteen per cent among primiparae.