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Re: Median vs. medio-lateral episiotomy. From: Efrain Ramirez (eramirezt@coqui.net) Sun Jun 24 18:56:02 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Meenan, Anna: "Re: Median vs. medio-lateral episiotomy." Previous message: Jamie: "Re: atypical eclampsia??" In reply to: Raymond Stephen: "Re: Median vs. medio-lateral episiotomy." Next in thread: Henry Gregor: "Re: Median vs. medio-lateral episiotomy." It has been years and years since my last mediolateral... Ef Obstetrics & Gynecology 2004;103:669-673 © 2004 by The American College of Obstetricians and Gynecologists This Article The Effects of Mediolateral Episiotomy on Pelvic Floor Function After Vaginal Delivery Andrea Sartore, MD, Francesco De Seta, MD, Gianpaolo Maso, MD, Roberto Pregazzi, MD, Eva Grimaldi, MD and Secondo Guaschino, MD >From the Department of Obstetrics and Gynecology, Istituto di Ricovero e Cura a Carattere Scientifico, Burlo Garofolo, University of Trieste, Italy. OBJECTIVE: To evaluate the effect of mediolateral episiotomy on puerperal pelvic floor strength and dysfunction (urinary and anal incontinence, genital prolapse). METHODS: Five hundred nineteen primiparous women were enrolled 3 months after vaginal delivery. Puerperae were divided in 2 groups: group A (254 women) comprised the women who received mediolateral episiotomy and group B (265 women) the women with intact perineum and first- and second-degree spontaneous perineal lacerations. Each woman was questioned about urogynecological symptoms and examined by digital test, vaginal perineometry, and uroflowmetric stop test score. Data were subjected to Student t test and Fisher exact test to assess, respectively, the difference between the mean values and the proportions within the subpopulations. Using a simple logistic regression model to test an estimate of relative risk, we expressed the odds ratios of the variables considered with respect to the control population (group B). RESULTS: No significant difference was found with regard to the incidence of urinary and anal incontinence and genital prolapse, whereas dyspareunia and perineal pain were significantly higher in the episiotomy group (7.9% versus 3.4%, P = .026; 6.7% versus 2.3%, P .014, respectively). Episiotomy was associated with significantly lower values, both in digital test (2.2 versus 2.6; P < .001) and in vaginal manometry (12.2 versus 13.8 cm water; P < .001), but not in uroflowmetric stop test. CONCLUSION: Mediolateral episiotomy does not protect against urinary and anal incontinence and genital prolapse and is associated with a lower pelvic floor muscle strength compared with spontaneous perineal lacerations and with more dyspareunia and perineal pain. Ef At Mon, 25 Jun 2007, Raymond Stephen wrote: > >Never lose sight of the fact that routine episiotomy is unwarranted - and that means with vacuums and forceps also. There have been many occasions in my experience where no episiotomy was necessary with assisted delivery. One should always wait until the perineum is distended and white, and then perform the smallest episiotomy that is required to allow the head to pass. If you do a J-shaped one the problem in sewing it up is getting it done without distortion. Even a medio-lateral incision can tear sideways into the rectum so it is no guarantee of safety. > >Steve > >-----Original Message----- >From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E. Siegel, M.D. >Sent: Saturday, 23 June 2007 10:50 PM >To: Multiple recipients of list OB-GYN-L >Subject: Re: Median vs medio-lateral episiotomy. > >Good discussion, and I do seem to find good luck with a small nick as >the head crowns that I can control the head. > >Dan, are you saying make a bigger one (i.e. the more traditional method >to which you refer) for forceps, vacuums, or whenever you feel that you >need one? > >Dan could be right and we've all just been lucky. . . > >Garry > >At Sat, 23 Jun 2007, Paul André Latulippe wrote: >> >>--Boundary_(ID_lqNLgZ89hcphD9D3Uvc03Q) >>Content-type: text/plain; charset=iso-8859-1; format=flowed >>Content-transfer-encoding: quoted-printable >> >>Hi >> >>I worked in France and I make the median >>episiotomy. I received many criticisms on this >>subject. But, often, when the perineum is near to >>tear, a small median notch makes it possible to >>direct the tear with less damage than the traditional episiotomy. >> >>Le 01:27 06/23/2007, vous avez écrit: >>>As a matter of fact, in this country small nicks >>>are called "episio de sage-femme" (midwife's epis). >>>Bernard >>> >CONFIDENTIALITY NOTICE AND DISCLAIMER > >The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission. If the transmission contains advice, the advice is based on instructions in relation to, and is provided to the addressee in connection with, the matter mentioned above. Responsibility is not accepted for reliance upon it by any other person or for any other purpose. -- “ The greatest obstacle to knowledge is not ignorance, it is the illusion of knowledge.” Daniel J. Boorstin - Historian Next message: Meenan, Anna: "Re: Median vs. medio-lateral episiotomy." Previous message: Jamie: "Re: atypical eclampsia??" In reply to: Raymond Stephen: "Re: Median vs. medio-lateral episiotomy." Next in thread: Henry Gregor: "Re: Median vs. medio-lateral episiotomy."

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