New article in AJOG shows episiotomy unnessary in SD

[Sophie's Mom]

Don't know if this has been posted yet.
- Tina


Routine episiotomy may be unnecessary
Source: American Journal of Obstetrics and Gynecology 2004; Not yet available online

Assessing rates of infant injury after births facilitated by episiotomy, physical rotation of the infant, or both.


Routine episiotomy does not help prevent injury to the infant in cases of shoulder dystocia, and should be preceded by manual attempts to facilitate delivery by rotating the infant, experts advise.

"Most textbooks in obstetrics still recommend that physicians perform a generous episiotomy, yet there is no evidence that the procedure will reduce the likelihood of injury to the infant," says lead author Edith Gurewitsch (Johns Hopkins University School of Medicine, Baltimore, Maryland, USA).

The investigators examined medical records for 127 severe cases of shoulder dystocia to see whether finishing delivery by performing episiotomy, physically manoeuvring the child in the birth canal, or carrying out both techniques had the best outcomes.

They found that the risk of brachial plexus palsy was no higher when delivery was managed only by rotating the infant (58 percent) than when both procedures were performed (60 percent). Moreover, in half of the cases when episiotomy was avoided, the women survived the birthing process with their vaginas intact.

"Episiotomy will only eliminate soft tissue barriers to delivery, whereas rotating the infant will realign its shoulders to fit with the mother's pelvis," explains the team. "Episiotomy is a surgical procedure that should only be performed when it is absolutely necessary," they conclude.

Posted: 8 October 2004