Episiotomy as a risk factor for early perineal trauma

Objective: To assess the association between medio-lateral episiotomy and early perineal trauma. Study Design: A prospective observational cohort study of 667 consecutive vaginal deliveries was conducted over a 10-week period. On the day following delivery, all women were examined for the extent of early perineal trauma (swelling, oedema, haematoma), in addition to the episiotomy or lacerations. The demographic and clinical variables (age, parity, gestational age, birthweight, length of second stage, operative delivery, epidural, seniority of the obstetrical provider, episiotomy) and the post-partum treatment given for the perineum were retrieved from the hospital records. Results: The overall episiotomy rate was 37.6%. Significant early perineal trauma was found in 9.9% of the women, more so in the episiotomy group (17.1% vs 5.5%, p<0.001). In the episiotomy group, a larger number of women received more than routine treatment for the perineum (6.4% vs 2.9%, p<0.05). Episiotomy was found to be the major independent predictor for perineal trauma (OR: 4.5, 95% Cl: 2.4-8.5, p<0.001), followed by epidural analgesia (OR: 2.4, Cl: 1.3-4.3, p<0.05) and birth weight >3700 g (OR: 2.1, Cl: 1.1 -4.1, p<0.05). Conclusion: Episiotomy does not prevent immediate post-partum perineal trauma rather, it is a major independent risk factor associated with significant early perineal trauma.