Benefits vs Risks of Episiotomy

What are the risks and benefits associated with episiotomy?

The following risks are frequent;

  1. If the area is not approximated with good surgical technique, the wound edges may not heal easily.
  2. Tight suture healing leads to formation of granulation tissue, spotting, and pain in some cases.
  3. A poorly healed end may be formed after an episiotomy, usually at the 6 o’clock position at the base of the vagina.  It causes severe pain with placing of a tampon, finger, or penis.
  4. Significant increase in maternal blood loss is another risk.
  5. A deep or extensive episiotomy may lead to intrapartum hemorrhage (excessive blood loss).
  6. The risk of an anal sphincter injury is increased with the most commonly performed midline episiotomy.
  7. The risk of poor wound healing is increased in a breast-feeding mother due to a decrease of estrogen levels in breast-feeding moms.
  8. Vaginal discomfort and pain due to vaginal dryness caused by decreased estrogen levels in breast-feeding moms.
  9. The amount of pain in the first several postpartum days is mostly underestimated.

Benefits include that episiotomies reduce anterior vaginal lacerations, which carry nominal morbidity.

Prevention of intracranial hemorrhage or intrapartum asphyxia, as well as birth trauma, is the main advantage of an episiotomy.

What is the greatest risk encountered during episiotomy?

Mediolateral and, to a minor degree, mid-line episiotomies considerably increase the quantity of blood loss at delivery.  Blood loss and possible anal sphincter damage are the greatest risks during episiotomy.  The most severe and underestimated is the anal sphincter damage, particularly with the midline episiotomy.  The rate of recurrence and severity varies from case to case. To determine the risk factors for anal sphincter injury during episiotomy, a great deal depends on variables such as vacuum assistance delivery of the newborn or delivery with forceps, as well as individual obstetric factors such as fetal weight, maternal pelvis and medical conditions, and the position of the fetus.

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