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  • Title: Comparison between two incision angles of mediolateral episiotomy in primiparous women: a randomized controlled trial.
    Author: El-Din AS, Kamal MM, Amin MA.
    Journal: J Obstet Gynaecol Res; 2014 Jul; 40(7):1877-82. PubMed ID: 25056465.
    Abstract:
    AIM: To compare two incision angles (60° vs 40°) of mediolateral episiotomy in primiparous Egyptian women, regarding the incidence of anal sphincter injury as well as episiotomy-related pain and dyspareunia. METHODS: The current prospective randomized controlled trial (ClinicalTrials.gov, NCT01930721) was conducted at Ain Shams University Maternity Hospital. Eligible women were randomized into two groups: group 1 included women who had the episiotomy incision made at an angle of 60° to the midline; and group 2 included women who had the episiotomy incision made at an angle of 40° to the midline. Primary outcome measures were differences in short-term related pain and rate of third/fourth degree perineal tears. RESULTS: A total of 330 primiparous women were recruited. The shortest distance to the outer edge of the anal epithelium was significantly shorter in women of group 2 when compared to that in women of group 1. Out of the included 330 women, 13 (4%) had third/fourth-degree perineal tears (4 [2.4%] in group 1 in contrast to nine [5.5%] in group 2). This difference was not significant A 60°-angled mediolateral episiotomy was associated with significantly higher rates of moderate/severe episiotomy-related pain post-partum. The rates of moderate/severe episiotomy-related pain and dyspareunia assessed 6 months post-partum were also higher among women of group 1, when compared to group 2; the latter two differences did not reach statistical significance, however. CONCLUSION: When compared to the 40°-angled mediolateral episiotomies, 60°-angled ones were associated with significantly higher short-term-related pain. Although they were also associated with lower rate of third/fourth-degree perineal tears and higher rate of long-term related pain and dyspareunia, these differences did not reach a statistically significant level.
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