Abstract

BACKGROUND:
Perineal trauma is a common event, affecting up to 90% of first time mothers. It is a cause for concern
for many women and in some countries has led to a large increase in the numbers of women
requesting elective caesarean section.
OBJECTIVE:
To highlight when episiotomy can be useful in preventing anal sphincter injury in primiparous
women.
MATERIALS AND METHODS:
This study is a prospective interventional clinical study conducted at AL-Elwiya Maternity Teaching
Hospital in Baghdad throughout the period between Jan. 2009- Dec. 2009.
Three hundred term primiparous ladies at time of their delivery with cephalic presentation were
collected and subdivided into 3 equal groups randomly.
The first group, women who were subjected to routine mediolateral episiotomy, while the second
group of the participants were delivered without doing episiotomy, and the third group, a mediolateral
episiotomy was done selectively to them when we found it is necessary (selective episiotomy).
State of the perineum, length of 2nd stage, weight of the baby, fetal head position and the occurrence
of anal sphincter injury were all notified and carefully recorded on special form designed for the
study.
RESULTS:
Selective episiotomy was found to be more useful than routine episiotomy in preventing anal
sphincter injury (the incidence of anal sphincter injury was 2% for those in whom episiotomy was
performed selectively, while it is 8% for those with routine episiotomy and 7% for those delivered
without episiotomy), and the difference is statistically significant (P value 0.045).
There was a significant effect of the length of second stage of labour on the incidence of anal
sphincter injury (P value 0.017), similarly for the weight of baby (P value 0.017).
CONCLUSION:
Selective episiotomy is more useful intervention than routine episiotomy in protecting the anal
sphincter when delivering a primiparous lady.