Practice Guidelines Briefs

AHRQ Review of Routine Episiotomy in Uncomplicated Births

Am Fam Physician. 2005 Jun 15;71(12):2383.

The Agency for Healthcare Research and Quality (AHRQ) has reviewed the use of routine episiotomy in uncomplicated vaginal births. “The Use of Episiotomy in Obstetrical Care: A Systematic Review” (AHRQ Evidence Report/Technical Review no. 112) appears in the May 1, 2005, issue of the Journal of the American Medical Association, and is available online at: http://www.ahrq.gov/downloads/pub/evidence/pdf/episiotomy/episob.pdf.

Researchers found that episiotomy performed during uncomplicated vaginal birth does not provide immediate or long-term benefit for the mother. Episiotomy is used in approximately one third of vaginal deliveries to hasten birth and prevent tearing of the perineum during delivery.

Women who had spontaneous tears of the perineum without episiotomy had less pain and no more complications related to healing than women with episiotomies. It also was noted that episiotomy did not protect women against urinary or fecal incontinence, pelvic organ prolapse, or difficulties in sexual function in the first three months to five years after delivery.

According to the AHRQ, a two-stage repair, which sutures the underlying layers of tissue but leaves the perineal skin unsutured, is more beneficial than a three-stage repair, which sutures the perineal skin. The researchers also found that continuous, subcuticular suturing may be superior to interrupted, transcutaneous suturing, and that polyglycolic acid sutures may be superior to chromium cat gut for episiotomy suturing.

Because the review did not include neonatal outcomes, possible benefits of episiotomy for babies were not addressed.


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