Not routinely performed for most normal deliveries

Done only if the perineum does not stretch adequately and is obstructing delivery.

A local anesthetic can be infiltrated if epidural analgesia is inadequate.

Prevents excessive stretching and possible irregular tearing of the perineal tissues, including anterior tears.

An episiotomy incision that extends only through skin and perineal body without disruption of the anal sphincter muscles, a 2nd-degree episiotomy, is usually easier to repair than a perineal tear.

Most common episiotomy is a midline incision made from the midpoint of the fourchette directly back toward the rectum.

Extension into the rectal sphincter or rectum is a risk with midline episiotomy.

A mediolateral incision made from the midpoint of the fourchette at a 45° angle laterally on either side, and usually does not extend into the sphincter or rectum.

Mediolateral incisions cause greater postoperative pain, is more difficult to repair, has increased blood loss, and takes longer to heal than midline episiotomy.

For episiotomy, a midline cut is often preferred.

Use of episiotomy is decreasing due to the concern over extension or tearing into the sphincter or rectum.

About 35% of women have dyspareunia after episiotomy.

Increases the rate of third and fourth degree perineal lacerations.

Midline preferred to medial lateral type.

Use is dropping in Western countries.

Typically adds nearly 3 cm. to posterior laceration length.

Can be used for nonreassuring fetal testing, preterm delivery, vaginal breech delivery, maternal exhaustion, prolonged second stage of labor and to facilitate operative vaginal delivery.

More likely with macrosomia.

About 1 million procedures each year and about 1000 women will develop fecal incontinence.

Routine use associated with no benefits and significant risks.

The routine episiotomy, with a normal delivery without complications or instrumentation, does not offer benefits in terms of reducing perineal or vaginal trauma. 

Rates of use among primiparous patients ranges from 40-92%.

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