Objective To compare the maternal and neonatal outcomes of restrictive use of episiotomy (only if tearing becomes apparent) versus routine episiotomy (in all cases). Methods 314 nulliparous women at ≥37 weeks of gestation with live singleton cephalic pregnancies and no contraindication to vaginal birth, who were recruited from November 2010 to March 2011 in this department, received restrictive use of episiotomy while 739 nulliparous women from January to November in 2010 underwent episiotomy as control group. In both groups, we strengthened cardiotocograph mornitoring and intrapartum care and improved the management of the perineum (hand on or hand off). Total duration of labor including the first and the second stages of labour, and blood loss in 2 hours postpartum were recorded as a continuous variable. Apgar scores and anal sphincter (third or fourth degree) tears were also recorded. Results No significant difference was observed in each stage of labour between the two groups ( P >0.05). Restrictive use of episiotomy resulted in more blood loss than in the control group ( P <0.01). Since the cases with severe perineum tear and neonatal asphyxia in both groups were rare, they were excused from Fisher’s exact test. However, the rate of neonatal asphyxia was a little higher in restrictive use group. Conclusions According to this clinical observation, the rate of episiotomy should and could be properly reduced, as the routine and restritive use of episiotomy results in no significant difference in labor duration, anal sphincter tear or neonatal asphyxia.
Key words
Restrictive use /
episiotomy /
perineal laceration /
neonatal asphyxia
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