Episiotomy in Modern Obstetrics: A Literature Review

Abstract

Episiotomy tends to be one of the main surgical procedures being performed in the wards of obstetrics. However, the trend is going down due to its more harmful side being highlighted more and more in the latest literature. This literature review explores the different aspects of episiotomy, including current recommendations, pelvic floor anatomy post-delivery, global episiotomy rates, the healthcare workers perspective and decision in performing episiotomies, what to consider when performing the surgical cut. The literature review also includes historical perspectives and how the rate of episiotomy has changed during the decades and different strategies that can be used to reduce the episiotomy usage.

Current recommendations to perform episiotomies is when there are clear indications indicated. Episiotomy is made during the second stage of labor when there is a cervix dilation of 3-4 centimeters. Those signs where the surgeon should perform an episiotomy are when the baby is under fetal distress, shoulder dystocia or when the mother’s pelvic outlet is very narrow, so we can prevent perineal tears.

The episiotomy rates worldwide tend to differ depending on what region and country we are talking about. The episiotomy rate in Latvia was around 19.8 percent during 2022, conversely, there are countries in Asia where the rates can reach up to 80 percent.

The factors considering during episiotomy can vary depending on what country we are talking about and the subjective view of the healthcare workers. However, factors typically taken into considerations include perineal stress, number of pregnancies, age, race and educations. In a study, it was also shown that 41 percent of women who received the episiotomy were not aware of the fact that they have received the surgical incision.

Additionally, this review investigates the correlation between episiotomy, perineal lacerations, OASIS and discusses the different approaches one can take to reduce the rate of episiotomy.

In conclusion, episiotomy is a topic in obstetrics with ongoing debate and differences of view and opinion considering where you are. However, as in today in 2024, the current recommendations are restrictive usage of episiotomy.