A Study of necessity of episiotomy in primigravida


1 Muhabat .S. Saeid, 2 Atiya K Muhammad, 3 Nokhsha R. Mohamed
1 University of Sulaimani, Medical Faculty ,Medicine School, 2 University of Sulaimani, Midical Faculty ,Nursing School, Maternal & Neonate H. Nsg, 3 Minstry of Health, Maternity Teaching Hosp.




Abstract
This prospective study has been carried out in Sulaimani Maternity Teaching Hospital, from
October 2006 to April 2007 to evaluate the outcome of those primigravida women delivered
vaginally without epiotomy who had not undergone episiotomy.
Purposive sample of (152) low risk primigravida women in the labour ward during 2nd stage of
labour has been selected to collect data properly. It should be noted that previous perineal operation,
malposition, instrumental delivery, premature babies, fetal distress, pelvic deformities, induction of
labour , short or rigid perineum, medical problems (like hypertension, diabetes, and heart
disease...ect), and have been excluded.
Questionnaire has been utilized as study institute, observations, checking &follow up for 24 hours,
1 week, 6 weeks have been used to achieve the main goals.
Through this study it was found that 34.9% of cases remain with intact perineum, 42.8% of cases
had 1st degree p. tear, 22.4% of cases had 2nd degree p. tears, and only 83 cases (54.6%) needed
suturing (49 cases with 1st degree tears &34 cases with 2nd degree tears). It was noted also that
complications in 1s 24 hours & after 1 week was less common in patients who had intact perineum.
On the bases of this study, we recommend that episiotomy should be restricted to specific
maternal or fetal conditions &routine use of episiotomy should be abandoned.

Keywords: Episiotomy, Primigravida



References:
[1] Lede RL, Belizan JM, Carroli G "Is routine episiotomy justified?" , American journal of
Obstetric&Gynecology.vol.174 No 5 May 1996:1399-1402
[2] Thacker SB, Banta HD. Benefits and risks of episiotomy: an interpretative review of the
English language literature, 1860-1980. Obstet Gynecol Surv 1983; 38:322-38.
[3] Sleep J, Roberts J, Chalmers I. Care during the second stage of labour. In: Chalmers I,
Enkin M, Keirse MJNC, editors. Effective care in pregnancy and childbirth. London:
Oxford Univ. Press, 1989; 1129.
[4] EMIS.Dr Paul Hewish. Episiotomy and Tears. Latest update © EMIS 2006.14Feb.2006.
[5] Lede R, Moreno M, Belizan JM. Reflexiones acerca de la indicacion rutinaria de la
episiotomia. Sinopsis Obstet Ginecol 1991; 38:161-6.
[6] Rob Stein, Washington Post staff Writer. May 4.2005. Procedure on Women In Labour
adds Risk Study Urges Halt To Episiotomies.
[7] TI-Routine vs selective episiotomy. A randamised controlled trial. Argentine Episiotomy
Trial Collaborative Group. SO-Lancet 1993.
[8] Carroli G, Belizan J.Episiotomy for Vaginal Birth .Cochrane Libbrary, Issue2.Chichester,
UK: John Wiley and Sons; January 6,2005. Is routine episiotomy justified? Hartmann K,
Viswanathan M, Palmieri R. Outcome of routine episiotomy:a systemic.
[9] JOHN T. REPEK, MD .When is episiotomy warranted? What is the evidence show? The
Journal of FAMILY PRACTICE. October 2003.vol 15 No 10
[10] Hartmann, k. et al. Outcome of Routine Episiotomy. Journal of American Medical
Association. May 2005; 293:2141-2148.
[11] D.KEITH EDMONDS.Dewhurt's Textbook of Obstetrics& Gynaecology.Seventh edition
2007.Page 225
[12] Factors Related to Genital Tract Trauma in Normal Spontaneous Vaginal Births. Leah L.
Albers, CNM, Dr PHI, Kay D. Sedler, CNM, MNI, Edward J. Bedrick, Ph DI, Dusty Teaf,
MA1, and Patricia Peralta 1.Birth ,Volum 33 Page 94-June 2006.