Abstract
Background: It is unclear the risk and benefit of restrictive or unrestrictive use of episiotomy.
Objective: To assess maternal and neonatal prognosis when we use episiotomy at delivery restrictively or unrestrictively.
Design: A retrospective cohort study.
Setting: Tertiary perinatal medical facility in Japan.
Study design: The unrestrictive use group included 299 vaginal deliveries between January 1 and December 31, 2015 before restricting episiotomy, and the restrictive use group included 256 vaginal deliveries between January 1 and December 31, 2018 after restricting episiotomy. We assessed perinatal prognosis in mothers and newborns and risk factors for severe lacerations.
Result: The episiotomy rate was 61％ in the unrestrictive use group and 32％ in the restrictive use group, which was significantly higher in the routine group（P ＜ 0.001）. Third-or fourth-degree lacerations were significantly fewer in the restrictive use group, at 8％ in the unrestrictive use group and 2.7％ in the restrictive use group（OR 3.104, 95％ CI 1.315-7.330, P＝0.007）. Additionally, labor time of the second stage was significantly longer in the restrictive use group. After adjusting for maternal age and presence or absence of episiotomy, the adjusted odds ratios for unrestricted incision, first birth, and instrumental delivery were 4.187（95％ CI 1.658-10.576）, 3.823（95％ CI 1.355-10.791）, and 6.479（95％ CI 2.728-15.388）, respectively, which were independent risk factors of severe perineal laceration.
Conclusion: We might be able to reduce severe perineal laceration with restrictive use of episiotomy at deliveries. It is desirable to perform episiotomy with limited indications.
