Selective Use of Episiotomy: the Impact on Perineal Trauma.

Summary

Vaginal delivery is commonly accompanied by trauma of the genital tract. Perineal trauma is classified into four degrees based on anatomic structures involved and severity of lacerations according to the American College of Obstetricians and Gynaecologists (ACOG) and the Royal College of Obstetricians and Gynaecologists (RCOG). Episiotomy is an intentional perineal incision performed by midwifes or obstetricians to enlarge vaginal opening during the second stage of childbirth and has become the most common surgical procedure worldwide. A routine use of episiotomy was proposed to prevent severe spontaneous lacerations, although it failed to to demonstrate a clear protective role with no benefits both for mother and baby. Therefore the guidelines changed in a selective use of episiotomy, and we have introduced it in our routine obstetrics care. Nevertheless, second-degree lacerations comprise a wide range of lesions, from a minimal involvement to a massive damage of the perineal muscles. Therefore, it was never confirmed that selective use of episiotomy reduce the perianal trauma in the range of second degree lesions.

We designed a prospective observational study with the introduction of a new classification of perineal trauma recorded with the usual data retrieved in delivery ward register. The aim is to definitively investigate if selective use of episiotomy reduce the overall perineal trauma.

Conditions

• Perineal Tear
• Episiotomy Wound
• Delivery; Injury, Maternal

Interventions

OTHER

Classification of perineal tears based on new classification

Classifications according to the American College of Obstetricians and Gynaecologists (ACOG) and the Royal College of Obstetricians and Gynaecologists (RCOG) and sub classification of second-degree lacerations based on the assumption that episiotomy involves the same anatomic structures of a second-degree laceration (perineal muscle, mucosa and skin), and divides them in two sub-groups, named A (if spontaneous vaginal tear is smaller than episiotomy) and B (if spontaneous vaginal tear is bigger than episiotomy).

PROCEDURE

Selective use of Episiotomy

Standardized selective use of Episiotomy as recommended by guidelines.

Sponsors & Collaborators

• Universita di Verona

  lead OTHER

Principal Investigators

• Simone Garzon, M.D. · Univerisity of Verona

• Massimo Franchi, M.D. · Univerisity of Verona

• Francesca Parissone, M.D. · Univerisity of Verona

• Cecilia Lazzari, M.D. · Univerisity of Verona

• Antonio Simone Laganà, M.D. · Università degli Studi dell'Insubria

• Giovanni Zanconato, M.D. · Universita di Verona

• Ricciarda Raffaelli, M.D. · Universita di Verona

Eligibility

Min Age

18 Years

Max Age

50 Years

Sex

FEMALE

Healthy Volunteers

No

Timeline & Regulatory

Start

2021-02-01

Primary Completion

2021-12-31

Completion

2022-04-30

Countries

• Italy

Study Locations