![]() 19 Other studies, however, have found that episiotomies were not protective against severe perineal lacerations, 8,9,20 and can actually increase the risk of third-degree and fourth-degree perineal tears in women who are multiparous. Depending on the study, the mediolateral episiotomy has been found to lower the incidence of OASI in spontaneous vaginal deliveries. 18 In Australia, the mediolateral episiotomy is generally preferred.ĭespite its common use in obstetrics, there is still conflicting evidence about the effectiveness of mediolateral episiotomy in the prevention of obstetric anal sphincter injuries (OASI). 17 Many different types of episiotomy incisions can be used, depending on the situation: midline, modified-midline, mediolateral, ‘J’-shaped, lateral, radical lateral and anterior. The aim of episiotomy is to increase the diameter of the vaginal outlet to facilitate the passage of the fetal head and, ideally, prevent a vaginal tear. Given that an episiotomy is considered to be a method to adequately reduce the rates of severe perineal tears, it is important to explore this ‘prophylactic measure’ in further detail. Delivery in lithotomy or deep squatting position.Prolonged second stage of labour (>60 minutes).Instrumental delivery (eg forceps, vacuum).The risks can be best separated into the following subgroups: maternal, fetal and intrapartum risk factors (Box 2). While there is a high risk for perineal trauma following any vaginal birth, it is particularly important to note the risk factors that contribute to severe perineal tears (third-degree and fourth–degree). 5–7 Fortunately, the incidence of perineal tears decreases with subsequent births, from 90.4% in women who are nulliparous to 68.8% in women who are multiparous undergoing vaginal deliveries. More than 85% of females who undergo a vaginal birth will suffer from some degree of perineal tear, 2 with 0.6–11% of all vaginal deliveries resulting in a third-degree or fourth-degree tear. ![]() Laceration extending through the anal epithelium (resulting with a communication of the vagina epithelium and anal epithelium) Where the external and internal anal sphincters are torn Where 50% of the external anal sphincter is torn Laceration involving the anal sphincter muscles, being further subdivided into 3A, 3B and 3C: Laceration involving the perineal muscles Laceration of the vaginal mucosa or perineal skin only
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