Episiotomy in modern obstetrics

Abstract

perineal trauma is an urgent problem of modern obstetrics. Episiotomy is one of the methods of prevention of severe perineal trauma during childbirth. Episiotomy is a surgical procedure to dilate the vaginal opening by cutting the perineum during the second period of labor in order to accelerate and facilitate the birth of the fetus during vaginal delivery. The overuse of episiotomy is still a significant problem in Ukrainian obstetrics. The article presents a literature review, meta-analyses and results of individual studies on the use of this procedure in modern conditions. Despite the fact that the use of episiotomy in modern obstetrics is limited, there are cases when it should be considered. Situations in which it can be useful include the need for accelerated vaginal delivery, operative vaginal delivery using vacuum extraction and obstetric forceps, as well as fetal shoulder dystocia, and a history of female genital mutilation. Types of episiotomy incisions are given. The most widely used types of episiotomy are median and mediolateral, which do not increase the risk of anal sphincter rupture. It is indicated that it is important to consider their risks and benefits when choosing an incision method. Recommendations are given for refusing to perform routine episiotomy for women who give birth vaginally, and the decision to perform it should be made on an individual basis, not routinely. The decision to perform an episiotomy largely depends on the clinical picture in the second period of labor and the opinion of the attending physician. The analysis showed that episiotomy has not lost its relevance in modern obstetrics. However, episiotomy may be associated with a higher rate of severe perineal trauma and wound complications. Thus, for women who give birth vaginally, it is recommended to refuse routine episiotomy. The decision to perform an episiotomy is made on an individual basis.