Objective The aim of this study was to investigate the maternal and neonatal morbidity related to use of episiotomy for vacuum and forceps deliveries. Design Retrospective population-based cohort study.Setting Dundee, Scotland.Population Two thousand one hundred and fifty three women who experienced an instrumental vaginal delivery between January 1998 and December 2002. Methods Univariate and multivariate logistic regression analyses were performed comparing deliveries with and without the use of episiotomy. Main outcome measures Extensive perineal tears (third and fourth degree) and shoulder dystocia.Results Two hundred and forty-one (11%) of the 2153 women who underwent instrumental vaginal deliveries did not receive an episiotomy. Vacuum delivery was associated with less use of episiotomy compared with forceps (odds ratio 0.10, 95% CI 0.07-0.14). Extensive perineal tears were more likely with use of episiotomy (7.5% vs 2.5%, adjusted OR 2.92, 95% CI 1.27 -6.72) as was neonatal trauma (6.0% vs 1.7%, adjusted OR 2.62, 95% CI 1.05-6.54). Use of episiotomy did not reduce the risk of shoulder dystocia (6.9% vs 4.6%, adjusted OR 1.43, 95% CI 0.74-2.76). The findings were similar for delivery by vacuum and forceps. Conclusion The use of episiotomy increased the risk of extensive perineal tears without a reduction in the risk of shoulder dystocia.

Our findings suggest an association between the DD genotype of the ACE gene and early-onset but not later-onset pre-eclampsia which may give a partial explanation for the higher recurrence risk with early-onset pre-eclampsia.

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Objective To determine the influence of intrapartum care during a first delivery on the risk of pelvic floor surgery in later life. Design Nested case -control study with record linkage of a historical cohort and a current morbidity database.Setting Hospital births in Dundee 1952Dundee -1966 Population The 7556 primiparous women from the Walker cohort. MethodsThe cases (n ¼ 352) were women who delivered a first singleton baby at term (!37 weeks) and subsequently had pelvic floor surgery. Controls (n ¼ 1403) were women who delivered their first baby during the same time period and did not undergo surgery. Univariate and multivariate logistic regression analyses were performed taking account of demographic, anthropometric and obstetric factors. Main outcome measure Pelvic floor surgery.Results Caesarean section was associated with a reduced risk of pelvic floor surgery compared with spontaneous vaginal delivery (odds ratio 0.16, 95% CI 0.05-0.55). Forceps delivery and infant birthweight >4.0 kg were not identified as significant risk factors (OR 0.94, 95% CI 0.71, 1.25, and OR 0.94, 95% CI 0.50, 1.75, respectively). Episiotomy and prolonged labour (>12 hours) may be associated risk factors but were of borderline significance (OR 1.46, 95% CI 0.99, 2.10, and OR 1.51, 95% CI 1.00, 2.27). Conclusion Caesarean section in a first pregnancy appears to protect against pelvic floor surgery in later life.