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Objective:  evaluating the effects of changing routine episiotomy performed in a teaching hospital setting to a selective medium lateral episiotomy policy and its effect on the risk of perineal tearing during spontaneous vaginal delivery. Methods:  cohort study with non-concurrent controls. Setting: Instituto Materno Infantil, a high risk, perinatal reference hospital. Intervention: employing an evidence based selective episiotomy policy. Inclusion criteria: women between 20-43 week gestation attending for spontaneous vaginal cephalic presentation delivery. Exclusion criteria: forceps delivery. Outcomes measured: frequency of episiotomy and perineal tears during 1999-2000 and 2002-2003 following evidence based educational intervention on April 2001. Results:  the selective episiotomy policy significantly decreased the overall rate of episiotomy from 47.3% (41.8-45.7, 95%CI) to 12.2% (10.2-14.6, 95%CI), significantly increased the rate of perineal laceration from 25.1% (23.4-26.9, 95%CI) to 37.6% (34.5-40.9, 95%CI), especially in nulliparas and did not significantly modify overall relative risk (RR) of perineal tearing (3.58 (2.96-4.33, 95%CI) to 2.14 (1.44-3.18, 95%CI)). Nullipara perineal tear RR had a non-significant increase from 3.83 (2.91-5.03, 95%CI) to 3.90 (2.38-6.44, 95% CI) whilst it significantly decreased for multiparas (4.06 (3.68-6.15, 95%CI) to 0.58 (0.34-0.98, 95%CI)). Selective episiotomy policy decreased the need for post partum perineal suture by 16.4% (p <0.05). Conclusions:  changing the episiotomy policy was successful as selective use decreased the frequency of episiotomy without significantly modifying the risk of perineal tearing in nulliparas and decreased the risk of perineal laceration in multiparas during spontaneous vaginal delivery. The need for post partum perineal sutures also decreased after a selective episiotomy policy had become established.

Política selectiva de episiotomía y riesgo de desgarro perineal en un hospital universitario