Midline and Mediolateral Episiotomy: Risk Assessment Based on Clinical Anatomy

Garner, Danielle K; Patel, Akash; Hung, Jun; Castro, Monica; Segev, Tamar G; Plochocki, Jeffrey H.; Hall, Margaret

doi:10.3390/diagnostics11020221

Cited by 9 publications

(11 citation statements)

References 50 publications

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“… 2 – 4 There are different types of episiotomy incisions, but the most commonly recommended and safest type is mediolateral episiotomy, in which the incision was made in the midline but directly downward and then laterally away from the rectum. 5 – 7 …”

Section: Introductionmentioning

confidence: 99%

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Prevalence of episiotomy practice and factors associated with it in Ethiopia, systematic review and meta-analysis

Figa

Chekole

Bedada

et al. 2022

Womens Health (Lond Engl)

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An episiotomy is one of the most commonly performed obstetrics surgeries indicated in emergencies during the second stage of labor like fetal distress, dystocia, and tight perineum. As a result, this systematic review and meta-analysis aimed to assess the prevalence of episiotomy practice and associated factors in Ethiopia. Ten cross-sectional studies with a total population of 3718 were included in this study. The search was done using online databases like PubMed, HINARI, Web of Science, other gray, and online repositories of Universities. All the included papers were extracted and appraised using the standard extraction sheet format of JOANNA Briggs Institute. The Cochran Q-test and I2 statistics test were used to test the heterogeneity of studies. To detect the publication bias of the included studies, a funnel plot and Egger’s test were used. The pooled prevalence of episiotomy practice and the odds ratio with a 95% confidence interval were presented using forest plots. The overall pooled prevalence of episiotomy practice was 45.11% (95% CI; 37.04–53.18; I2 = 96.3%). Prolonged second stage of labor (OR: 4.79, 95% CI: 3.03, 7.57), face presentation (OR: 4.26, 95% CI: 1.21, 15.07), birth weight > 4000 g (OR: 6.71, 95% CI: 3.14–14.33), instrumental delivery (OR: 4.26, 95% CI 2.95, 6.14), and primiparity (OR: 3.70, 95% CI: 1.90, 7.2) were factors associated with episiotomy practice. The overall prevalence of episiotomy practice was higher in Ethiopia compared to studies conducted in other countries. The prolonged second stage of labor, face presentation, birth weight > 4000 g, instrumental delivery, and primiparity of women were the factors associated with episiotomy practice. Therefore, efforts should be made to prevent routine episiotomy practice through creating awareness, adjusting national guidelines, affecting the World Health Organization episiotomy policy, and monitoring the activities of the health care facilities in executing the protocols.

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Section: Introductionmentioning

confidence: 99%

“… 19 The extent of episiotomy practice was determined by the presence or absence of the protocol or policy for health care providers, work experience, and professions. 7 , 20 …”

Section: Introductionmentioning

confidence: 99%

Prevalence of episiotomy practice and factors associated with it in Ethiopia, systematic review and meta-analysis

Figa

Chekole

Bedada

et al. 2022

Womens Health (Lond Engl)

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“…The incision is made vertically over the perineum The incision is made at an angle over the perineum Open access journal under a CC-BY license. Contributed by Garner et al [10].…”

Section: Median or Midline Episiotomy Mediolateral Episiotomymentioning

confidence: 99%

“…The difference between median episiotomy and mediolateral episiotomy is depicted in Table 1 . Figure 1 depicts the mediolateral and midline incision for episiotomy [ 10 ].…”

Section: Reviewmentioning

confidence: 99%

A Review of Episiotomy and Modalities for Relief of Episiotomy Pain

Choudhari¹,

Tayade²,

Venurkar³

et al. 2022

Cureus

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Episiotomy is a surgically planned incision of the perineum and the posterior vaginal wall in the second stage of labour. It is one of the most commonly performed surgical procedures in the world. In episiotomy, the vaginal orifice is made larger to facilitate the birth of a baby. The postnatal period is very crucial in every mother's life, especially those who had a vaginal delivery and underwent episiotomy. Maternal benefits of episiotomy include reduced risk of perineal trauma, subsequent pelvic floor dysfunction and prolapse, urinary incontinence, faecal incontinence, and sexual dysfunction. Potential benefits for the foetus are thought to include a shortened second stage of labour. However, an episiotomy can also lead to potential adverse consequences, including the extension to a third-or fourth-degree tear, anal sphincter dysfunction, and dyspareunia. Different approaches can be adopted to reduce these complications in the postpartum period, including cleanliness, cold packs, sitz baths, kegel exercises, perineal care, and topical application of dry heat-infrared lamp therapy. Of all these approaches, infrared lamp therapy and sitz baths are the two most effective and commonly used for episiotomy pain relief and wound healing. In infrared lamp therapy, radiant heat or infrared rays are used to produce heat that is then applied to the episiotomy wound to facilitate pain relief and wound healing, while a sitz bath is a moist heat application process that is also effective for episiotomy pain relief and wound healing. This review aims to offer the most thorough understanding of episiotomy, its current concept, and episiotomy pain relief, with a particular focus on infrared lamp therapy and sitz baths.

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“…Kostov and colleagues evaluated and described a series of anatomical variations in the ureters, pelvic vessels, and nerves that are relevant to the common surgical procedure of pelvic lymphadenectomy [6]. Finally, in a potentially revolutionary study, Garner, Plochocki, Hall, and colleagues describe how anatomical variation affects the potential for iatrogenic damage during episiotomy [7]. They discovered that episiotomies involving a midline incision resulted in a reduced risk of injury to nerves, erectile tissue, muscles and glands of the region than those involving mediolateral incisions.…”

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confidence: 99%