<- Home <- Arhive <- Vol. 5, Issue 3, September 2009

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Episiotomy - The Destructive Tradition -

M. Stark

Abstract: The time-honoured Episio to my fails to fulfil the expectations for which it was introduced. It does not decrease the perineal damage, does not pre vent prolapse but increases morbidity and blood loss. When performed, however, it should be repaired in an optimal way. The short-term outcome of episiorrhaphies, when leaving the vaginal wall unsutured and closing the deep layers and skin continuously. In a randomized prospective pilot study 43 primiparae sutured with the traditional three layers closure were compared to 46 primiparae sutured with a modified - two layers closure. Major parameters included the presence of hematomas, local redness and swelling, use of pain killers, and distortion of anatomy after 6-8 weeks. Statistical analysis used t-test in SPSS for Windows. There was no significant difference between both groups concerning hematomas, local redness and swelling in the first 24 and 48 hours. The need for painkillers was similar in both groups after 24 hours and there was a non-significant trend toward less need for painkillers after 48 hours. Among the women who were examined after 6 weeks there was no significant difference concerning local discomfort and pain, but there was a significantly less distortion of anatomy in the two layers group. Episiotomies should be performed only when absolutely indicated. Compared to the three layers episiorrhaphy method, the modified two-layer method, proved to reduce pain and resulted in restitution of the anatomy. Whether in long term the two layers episiorrhaphy will prevent inclusion cysts and dyspareunia should be a subject for future long-term prospective randomized studies.
Keywords: Episiotomy, Episiorrhaphy, two layers repair

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