Comparison of Routine Versus Restrictive Episiotomy in term Pramigravidas with Singleton Pregnancy

Abstract

Objective: To compare routine versus restrictive episiotomy in term pramigravidas with singleton pregnancy.

Methodology: A randomized controlled trial was conducted in the Department of Gynecology at Lahore General Hospital, Lahore from June 2020 till Dec 2020. Pregnant primiparous women aged 18-40 years, with a viable fetus weighing less than 4000 grams, a gestational age of ≥ 37 weeks, a BMI of less than 30, and no history of pelvic surgery or neuromuscular diseases, were included. The women were randomly allocated into two groups. In group I, women underwent routine prophylactic mediolateral episiotomy when crowning occurred. In the second group, episiotomy was performed only when specified maternal or fetal indications required it to facilitate vaginal delivery.

Results: The overall mean age of the cases was 28.92 ± 6.29 years, with the routine group having a mean age of 29.41 ± 6.52 years, and the restrictive group having a mean age of 28.44 ± 6.03 years. In the restrictive group, 10 cases (5.9%) had an intact perineum, while only 3 cases (1.8%) in the routine group had an intact perineum. The frequency of an intact perineum was significantly lower in the restrictive group compared to the routine group (p = 0.048). The mean blood loss in the routine group was 249.24 ± 51.02 ml, while in the restrictive group, it was 226.45 ± 14.77 ml. The mean blood loss in the restrictive episiotomy group was significantly lower than in the routine episiotomy group (p-value < 0.001).

Conclusion: As per the findings of this study the restrictive group yielded observed with better outcome in terms of higher intact perineum rate and less blood loss when compared with routine group.