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Re: episiotomy and its effects on perineal body/external an From: Robert J. Woolley (wooll005@gold.tc.umn.edu) Wed Apr 30 23:26:14 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Previous message: Harvey S. Marchbein, M.D.: "Re: episiotomy and shoulder dystocia" In message <199705010154.VAA05294@neptune.ivic.qc.ca> writes: > > I had my training in the province of Quebec. We always do midlines. > Mediolaterals are more painfull, What is your evidence for this assertion? There is none, to my knowledge. difficult to repair, What is your evidence for this assertion? There is none, to my knowledge. have more > bleedings, This appears to be true; a large, well-designed case-control study confirmed it. have more infections What is your evidence for this assertion? There is none, to my knowledge. And actually there is good evidence to the contrary, since the best studies show no increase in infection (compared with no epis) for mediolaterals, and only one study has addressed the rate of perineal infections for midlines, and that one found a higher rate after midline than after no epis. and more dyspareunia What is your evidence for this assertion? There is none, to my knowledge. but we save the > anorectal area. Yes, though only when compared to midlines, not when compared to no epis. When compared to no epis, the bulk of the evidence is for no increased or decreased risk of sphincter damage. However, there are two reasonable-quality studies that show an increased risk with mediolateral (compared to none) and one that showed a protective effect. > > The only disadvantage with midlines is to have to repair the > anorectal area but when you are training for that it`s better for > your patient. "It's better" is a highly subjective assessment. How do you so definitively weight the relative advantages and disadvantages? Frankly, if I were a parturient woman and were asked to choose one or the other, I'd be hard-pressed. --------------------------------------------------------------------------- --------------------------------------------------------------------------- Bob Woolley -- --------------------------------------------------------------------------- St. Paul, Minnesota "There is no such thing as a good or bad book. It is either well-written or badly written; that is all." --Oscar Wilde Previous message: Harvey S. Marchbein, M.D.: "Re: episiotomy and shoulder dystocia"

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