الفهرس 
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Abstract
Episiotomy, one of the most common surgical procedures, first introduced to clinical practice in the eighteenth century without having strong scientific evidence of its benefits.
Later it was justified by the prevention of sever perineal tears, better future sexual function and a reduction of urine and fecal incontinence .
There is no reliable evidence that routine use of episiotomy has any beneficial effect on the contrary there is clear evidence that it may cause harm such as a greater need for surgical repair and a poorer future sexual capability.
The claims of a protective effect on the fetus in shortening the second stage of labor, improving Apgar score and preventing perineal asphyxia has not been born out.
Although episiotomy decrease the occurance of anterior lacerations, it has failed to accomplish the majority of goals stated as reasons for its use, episiotomy does not decrease damage to the perineum it rather increase it, episiotomy fails to prevent the development of pelvic relaxation and its attendant complication. ,also there are very limited data on the effect of episiotomy on the risk of obstetric laceration in subsequent deliveries. In the present study, 200 patients were selected from those attending the obstetrics outpatient clinic at El Shatby Hospital, Alexandria University during period of time from July. 2010 till March 2011.
All our patients had vaginal deliveries of live born term singleton fetuses with vertex presentation.
Spontaneous perineal laceration in the second vaginal deliveries designated the primary outcome of interest.
We examined our patients when they were in 2nd delivery taking full history examination before and after delivery.
The patients were classified into two groups Group 1(Control) included 100 patients with no history of episiotomy. Group 2:case group included 100 patient with history of episiotomy in their 1st delivery.
Examination after delivery the case group rarely have an intact perineum only 16% while 58% of control group have an intact perineum, the control group resulted in 31% tear only, while the case group had 54% tear the p. value is highly significant. The rest of the patients need 2nd episiotomy 11% control, 30 % cases. So it is clear that previous episiotomy increases the risk of perineal lacerations in a subsequent vaginal delivery.
Our results provide compelling evidence that episiotomy in a first vaginal delivery significantly increases the risk of spontaneous laceration in a subsequent delivery. This finding adds to the evidence that episiotomy is associated with maternal morbidity and recognition that the risk of this procedure is not limited to the index delivery, but is continue to future deliveries. We encourage obstetric care providers to further restrict the use of episiotomy.