Episiotomy versus no-episiotomy approach and its impact on severe perineal trauma: An institutional experience.

Objective: To compare the frequency of third and fourth degree perineal tears with and without episiotomy in mothers undergoing vaginal delivery. Study Design: randomized controlled trail Place and Duration: Labour Ward Emergency of Obstetrcics and Gynaecology Department of Nishtar Hospital, Multan, from 1st January to 31st December 2017. Methodology: Total 1000 patients divided equally in two groups, episiotomy (group-A) and no-episiotomy (group-B) fulfilling the inclusion criteria of full term pregnancy, full cervical dilatation,well engaged fetal head and maternal urge to push were included in the study. The patients with history of surgically treated fourth degree perineal tears were excluded. The maternal outcome in terms of frequency of episiotomy, instrumental delivery and perineal trauma including third and fourth degree tears were observed alongwith other demographic variables. Results: Episiotomy was observed as 26.6% and 7.8% for the episiotomy and no -episiotomy groups respectively. The outcomes of third degree and fourth degree was observed as 1% and 0.6% respectively in episiotomy group. The outcomes of third degree and fourth degree was observed as 1% and 0.8% respectively in no-episiotomy group. The coefficients were statistically significant in primigravida and mode of delivery (p=0.000) being more common with forceps. Episiotomy has insignificant relationship with severe perineal trauma. Conclusion: There is no difference in frequency of severe perineal trauma with and without episiotomy approach in women undergoing vaginal delivery. [ABSTRACT FROM AUTHOR]