Benefits vs Risks of Episiotomy

Benefits vs Risks of EpisiotomyBenefits vs Risks of EpisiotomyWhat are the risks and benefits associated with episiotomy?

Risks: The following risks are present with episiotomies:

1. If the episiotomy is not done in the correct surgical technique, the wound edges may not heal well.

2. Tight suture healing leads to formation of granulation tissue, spotting, and pain in some cases.

3. The anal sphincter may be damaged by a midline episiotomy. This can cause severe pain when inserting a tampon, finger, or penis.

4. Significant increase in maternal blood loss can be caused by an episiotomy.

5. A deep or extensive episiotomy may lead to intrapartum hemorrhage (excessive blood loss).

6. The risk of an anal sphincter injury is increased with a midline episiotomy, which is the most commonly performed episiotomy.

7. The risk of poor wound healing is increased in a breast-feeding mother due to a decreased level of estrogen in breast-feeding mothers.

8. Vaginal discomfort and pain due to vaginal dryness caused by decreased estrogen levels in breast-feeding moms can further inhibit healing and increase pain.

9. The amount of pain in the first several postpartum days is usually underestimated and more severe than expected.

Benefits: Episiotomies reduce anterior vaginal lacerations, which carry nominal morbidity. Prevention of intracranial hemorrhage or intrapartum asphyxia, as well as birth trauma, is the main advantage of an episiotomy.

What is the greatest risk encountered during episiotomy?

The greatest risks of episiotomies are the increased blood loss during delivery and the possible sphincter damage they can incur. The most severe and underestimated risk is anal sphincter damage, particularly with a midline episiotomy.  The rate of recurrence and severity varies from case to case. The risk factors for anal sphincter injury during episiotomy depend on variables such as vacuum assistance delivery of the newborn or delivery with forceps, as well as individual obstetric factors such as fetal weight, maternal pelvis and medical condition, and the position of the fetus.

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