Maternal morbidity in vaginal delivery with episiotomy.

Thesis Report.

ABSTRACT: This study was conducted in the Department of Obstetrics and Gynaecology at T.U. Teaching Hospital in the year 1999/2000. Objective: The main objective was to study the maternal morbidity during first vaginal birth in women with episiotomy. Methodology: This was hospital-based descriptive, prospective and cross- sectional study. The study comprised a group of 300 women delivered vaginally for the first time including previous LSCS and abortions. The main outcome measures recorded were: number of women having an episiotomy, without episiotomy, instrumental delivery rate, severe vaginal/ perineal injuries excessive haemorrhage or haematoma attendant at delivery, cases repaired under anaethesia and birth weight. Results: The main findings identified were; i. Total episiotomy rate was 81%. ii. Spontaneous tear was 7%. iii. Total perineal surgical repair became 88%. iv. 95% of instrumental delivery was performed by giving episiotomy. v. The rate of episiotomy was found to be higher among trainees than the trained manpower. vi. By comparison, episiotomy group sustained more tear extension than the no episiotomy group. vii. Third-degree perineal tear, haematoma and suclus tear were significantly associated with the use of forceps, excessive birth weight, vacuum and episiotomy. viii. intact perineum, was high among no episiotomy group. ix. Anterior perineal lacerations were slightly lower among episiotomy group. Conclusion : The women with first vaginal births had high rate of episiotomy, low intact perineum and more surgical perineal repair. Third-degree perineal tear and other complications were associated with the use of instrumental deliveries, larger birth weight and episiotomy. So by the present study the following recommendations can be made: i. Routine policy of episiotomy seems unjustified. ii. Episiotomy should not be considered to prevent insignificant anterior perineal lacerations. iii. Episiotomy should be performed only to the specified feto-maternal indications. iv. Proper precaution should be taken during instrumental delivery to prevent perineal tear extensions.

Eng.