Episiotoomiat

Episiotoomia, also known as perineotomy, is a surgical incision made in the perineum and the posterior vaginal wall during childbirth. The perineum is the area between the anus and the vulva. This procedure is performed to enlarge the vaginal opening, theoretically to facilitate the delivery of a baby.

Historically, episiotomies were a routine procedure in many parts of the world. The rationale behind performing them included preventing perineal tears, reducing the risk of fetal distress, and protecting pelvic floor muscles. However, evidence from numerous studies has led to a significant shift in practice. Current recommendations generally advise against routine episiotomies.

Instead, episiotomies are now typically performed only when there is a specific medical indication. These indications can include a need for rapid delivery due to fetal distress, an abnormally large baby, or a very tight perineum that is likely to tear extensively.

There are two main types of episiotomies: midline and mediolateral. A midline episiotomy is a vertical incision from the posterior fourchette downwards. A mediolateral episiotomy is made at an angle from the posterior fourchette towards the anus. The choice of incision depends on the obstetrician's judgment and the clinical situation.

Following childbirth, any episiotomy is repaired with sutures. Potential complications of episiotomy include increased pain, bleeding, infection, and a higher risk of more severe perineal tears, including those that extend into the anal sphincter. The decision to perform an episiotomy should be made on an individual basis, weighing the potential benefits against the risks.