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Re: ?? Elective EpisiotomyFrom: Jane Helwig, MD (jane@seasonedsystems.com)Wed Mar 24 19:18:45 1999
At Wed, 24 Mar 1999, D.Ingham RM wrote: > >A lady in my care, G3P2, is now 30/52 gestation. During her first >delivery she had an episiotomy and a further 3rd degree tear (involving >anal sphincter and taking six months to heal) For her second delivery >her OB advised an elective episiotomy, which was done but she also had a >tear along the previous tear site, although not 3rd degree. She is now >keen to avoid another episiotomy. Is an elective episiotomy advisable >again? >thanks >Debbie Agree with Bob, Kathi, and Garry. I have taken care of many patients with one or more previous episiotomies, some with previous 3rd or 4th degree extensions, who did not want repeat episiotomies. Virtually all of them have delivered without an episiotomy. So far, I have never seen one of these patients have a 3rd or 4th degree tear. It is common to see 2nd degree lacerations, but a fair number deliver over an intact perineum. It is a benefit in these cases that the patient is now a multip and thus less likely to require operative delivery, itself a risk factor for perineal lacerations. (Although, as Bob knows, I don't believe operative delivery requires episiotomy.) Jane
-- Jane Helwig, MD Private practice Nassawadox, VA
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