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Re: ?? Elective EpisiotomyFrom: Robert J. Woolley (wooll005@tc.umn.edu)Wed Mar 24 21:10:35 1999
In message <199903250218.UAA17683@talk.obgyn.net> writes: > > 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 Indeed. Before I e-met Jane here, I had already admired her study: [From my review article] A similar records review was performed by Helwig et al in North Carolina [62]. They identified 392 successful operative vaginal deliveries in 1989 and 1990 that met their criteria: singleton, vertex, with either midline or no episiotomy. (It is striking that 60% of their operative deliveries did not use episiotomies.) To identify risk factors for third-degree lacerations, they performed univariate analysis on the use of episiotomy and 14 other variables; unlike Combs et al [61], these investigators included several fetal variablesÑbirth weight, fetal distress, meconium, and shoulder dystocia. Of all these, only episiotomy, birth weight, and parity proved significant. The data were then stratified by parity and birth weight. The risk of third-degree laceration was greater with episiotomy than without in each of the four subgroups created by this stratification. The final overall estimate was a 2.4-fold increased risk of anal sphincter damage when episiotomy was performed. Referencing: 62. Helwig JT, Thorp JM, Bowes WA. Does midline episiotomy increase the risk of third- and fourth-degree lacerations in operative vaginal deliveries? Obstet Gynecol 1993; 82:276-9. ---------------------------------------------------------------------------
--------------------------------------------------------------------------- Bob Woolley -- --------------------------------------------------------------------------- St. Paul, Minnesota
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