الفهرس 
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Abstract
Episiotomy, the commonest intervention during childbirth, was
first introduced for complicated deliveries, but in many countries it
became a routine policy in clinical practice without scientific evidence
of its benefits (Röckner G, Fianu-Jonasson, ١٩٩٩).
The best available data do not support liberal or routine use of
episiotomy. Nonetheless, there is a place for episiotomy for maternal
or fetal indications, such as avoiding severe maternal lacerations or
facilitating or expediting difficult deliveries (ACOG, ٢٠٠٦).
The aim of this work is to compare the short term outcome of
the current practice of routinely employing episiotomy in primiparous
women to a policy of restricting episiotomy use to specific fetal and
maternal indications.
The study included ٢٠٠ healthy primiparous women, with
uncomplicated, living, Singleton intrauterine pregnancy with
gestational age >٣٧ weeks, who were divided randomly into ٢ equal
groups:
• Routine episiotomy group (group I): ١٠٠ primiparous women
in whom routine right mediolateral episiotomy was done.
• Restricted episiotomy group(group II): ١٠٠ primiparous
women in whom right mediolateral episiotomy was done for
specific fetal or maternal indicationsbr>In the restricted episiotomy group episiotomy was done if:
Maternal indication: A tear is judged to be imminent when the
perineum will be extremely thin and pale with the head crowned
during contraction to a diameter of about ٤-٥ cm (Dannecker et al,
٢٠٠٤).
Fetal indication: fetal distress; marked by prolonged fetal
bradycardia or late deceleration during the ”perineal phase” of the
second stage of labor (Siraj and Johanson, ٢٠٠٠).
In conclusion, this study demonstrated that, on following the
restrictive policy in doing episiotomy which limits the use of
episiotomy to certain indications:
١- There was a great reduction of episiotomy rate (١٩%) without
significant increase in the rate of perineal tears or lower genital
injuries.
٢- Although there was a higher rate of anterior perineal tear (٢١%
versus ١٦%), in practice, however, anterior lacerations are not
associated with known clinically significant adverse outcomes.
٣- Significant reduction in the Hct% loss.
٤- As regard the need for analgesia, there was a statistical
significant difference between the two groups. The need for
analgesia was ٥٧% in restricted group versus ٩١% of routine
group>٨٣
٥- There was no difference between the two groups concerning the
fetal outcome.
Similarly, Hartman et al,(٢٠٠٥) found no benefits from
episiotomy and they identified good evidence suggesting that
immediate outcomes following routine use of episiotomy are not
better than those of restrictive use.
Indeed, routine use is harmful to the degree that some
proportion of women who would have had lesser injury instead had a
surgical incision.
Use of episiotomy should be restricted to specific fetal and
maternal indications in primiparas.
The time has come to take on the professional responsibility of
setting and achieving goals for reducing episiotomy use.
Clinicians need to work within hospitals, practices, and birthing
centers to better track the prevalence of circumstances that likely
warrant use, such as fetal distress, to refine target rates that fit the
characteristics and labor experiences of the populations.
As episiotomy is used less, opportunities will be gained to
better study other techniques intended to prevent or reduce perineal
injury.