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The Effects of Mediolateral Episiotomy on Pelvic Floor Function After Vaginal Delivery

From the Department of Obstetrics and Gynecology, Istituto di Ricovero e Cura a Carattere Scientifico, Burlo Garofolo, University of Trieste, Italy.

Address reprint requests to: Dr. Andrea Sartore, Department of Obstetrics and Gynecology, I.R.C.C.S. "Burlo Garofolo," University of Trieste, Italy, Via dell'Istria 65/1–34137 Trieste, Italy; e-mail: sartore{at}burlo.trieste.it.

OBJECTIVE: To evaluate the effect of mediolateral episiotomy on puerperal pelvic floor strength and dysfunction (urinary and anal incontinence, genital prolapse).

METHODS: Five hundred nineteen primiparous women were enrolled 3 months after vaginal delivery. Puerperae were divided in 2 groups: group A (254 women) comprised the women who received mediolateral episiotomy and group B (265 women) the women with intact perineum and first- and second-degree spontaneous perineal lacerations. Each woman was questioned about urogynecological symptoms and examined by digital test, vaginal perineometry, and uroflowmetric stop test score. Data were subjected to Student t test and Fisher exact test to assess, respectively, the difference between the mean values and the proportions within the subpopulations. Using a simple logistic regression model to test an estimate of relative risk, we expressed the odds ratios of the variables considered with respect to the control population (group B).

RESULTS: No significant difference was found with regard to the incidence of urinary and anal incontinence and genital prolapse, whereas dyspareunia and perineal pain were significantly higher in the episiotomy group (7.9% versus 3.4%, P = .026; 6.7% versus 2.3%, P = .014, respectively). Episiotomy was associated with significantly lower values, both in digital test (2.2 versus 2.6; P < .001) and in vaginal manometry (12.2 versus 13.8 cm water; P < .001), but not in uroflowmetric stop test.

CONCLUSION: Mediolateral episiotomy does not protect against urinary and anal incontinence and genital prolapse and is associated with a lower pelvic floor muscle strength compared with spontaneous perineal lacerations and with more dyspareunia and perineal pain.

LEVEL OF EVIDENCE: II-2

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