A comparative study of perineal morbidity in vaginal delivery with and without episiotomy


  • Priyankur Roy Department of Obstetrics & Gynaecology, JSS Hospital, Mysore, Karnataka, India
  • Sujatha M.S. Department of Obstetrics & Gynaecology, JSS Hospital, Mysore, Karnataka, India
  • Bivas Biswas Department of Obstetrics & Gynaecology, King’s Mill Hospital, Sutton in Ashfield, Nottinghamshire, U.K.
  • Anumita Chatterjee Department of Obstetrics & Gynaecology, JSS Hospital, Mysore, Karnataka, India
  • Pijushkanti Roy Department of Obstetrics & Gynaecology, Roy’s Clinic, Siliguri, West Bengal, India




Restricted episiotomy, Universal episiotomy, Perineal dysfunction


Background: The objective was to determine the occurrence of perineal morbidity in women who delivered vaginally with an episiotomy versus those who delivered without.

Methods: Primigravid women were enrolled into the study on documentation of full dilatation of the cervix and randomized into either the study group (delivered without an episiotomy) or Control Group (delivered with an episiotomy). All labours were carefully monitored with intermittent auscultation of foetal heart rate and partograph was plotted for everyone. Labour was augmented with oxytocin infusion if required. Good perineal and para urethral support at the time of crowning of the head and during delivery of the baby was given for patients of both the groups. Right mediolateral episiotomy was given for the control group. Perineum was then examined and if any lacerations were noted it was sutured, if necessary, as per standard protocol (vicryl rapide was used). Episiotomy was sutured in 3 layers with vicryl rapide.

Results: The total number of patients studied was 300 – equally distributed in both the groups. The age group of the patients and birth weight of the babies were comparable. In the study group, 22.0% patients had no lacerations in the perineum. Inspite of an episiotomy, 15.34% had anterior and posterior perineal lacerations and in that 4.67% patients had anal sphincter tear. 9 patients had more than 50% of EAS torn but none of them complained of incontinence during their follow-up. 68.37% patients in the control group had persistent perineal pain for more than one week versus 19.42% in the study group. 4.27% patients in the control group had persistent pain whereas no patients in the study group had pain more than 2 months.

Conclusions: Short term perineal morbidity is significantly lower in parturients who delivered without an episiotomy and that episiotomy did not offer protection against sustaining severe perineal lacerations.


Sleep J, Grant A, Garcia J, Elbourne D, Spencer J, Chalmers I. West Berkshire – Perineal Management Trial. BMJ. 1984;289(6445):587-90.

Sreevidya S, Sathiyasekaran BW. High caesarean rates in Madras (India): A population-based cross sectional study. BJOG. 2003;110(2):106-11.

Jeffrey L. Ecker, Winona M. Tan, Raj K. Bansal, Judith T. Bishop, Sarah J. Kilpatrick. Is there a benefit to episiotomy at operative vaginal delivery? Observations over 10 years in a stable population. Am J Obstet Gynecol. 1997;176(2):411-4.

Renfrew MJ, Hannah W, Albers L, Floyd E. Practices that minimise the trauma to the genital tract in child birth: A systematic review of the literature. Birth. 1998;25(3):143-60.

Graves EJ. Summary: National hospital discharge survey. Advance data from vital health statistics, 1995.

Myers-Helfgott MG, Helfgott AW. Routine use of episiotomy in modern obstetrics: Should it be performed? Obstet Gynecol Clin North Am. 1999;26(2):305-25.

Belizan J, Campodonico L, Carroli G, Gonzalez L, Lede R. – Argentine Collaborative Trial. Routine vs selective episiotomy: A randomized controlled trial. Lancet. 1993;342(8886-7):1517-8.

Alison Macfarlane. At last maternity statistics for England- Department of Health. BMJ. 1998;316(7131):566-7.

Thacker SB, Banta HD. Benefits & risks of episiotomy: An interpretive review – 1860-1980. Obstet Gynecol Surv. 1983;38(6):322-38.

De Leeuw JW, Struijk PC, Vierhout ME, Wallenburg HCS. Risk factors for 3rd degree perineal ruptures during delivery. BJOG. 2001;108(4):383-7.

Angioli R, Gomez-Marin O, Cantuaria G. Severe perineal lacerations during vaginal delivery: The University of Miami experience. Am J Obstet Gynaecol. 2000;182:1083-5.

Deering SH, Carlson N, Stitely M, Allaire AD, Satin AJ. Perineal body length and lacerations at delivery. J Reprod Med. 2004;49(4):306-10.

Fernando RJ, Sultan AH, Kettle C, Radley S, Jones P, O'Brien PM. Repair techniques for obstetric anal sphincter injuries: A randomized controlled trial. Obstet Gynaecol. 2006 Jun;107(6):1261-8.

Macarthur AJ, Macarthur C. Incidence, severity & determinants of perineal pain after vaginal delivery: A prospective cohort study. Am J Obstet Gynecol. 2004;191(4):1199-204.

Martin S, Labrecque M, Marcoux S, Berube S, Pinault JJ. The association between perineal trauma and spontaneous perineal tears. J Fam Pract. 2001;50(4):333-7.






Original Research Articles