Episiotomy and perineal tears presumed to be imminent: randomized controlled trial

Background.  The indication of the restricted use of episiotomy at tears presumed to be imminent is not clear. Methods.  Randomized controlled trial with two perineal management policies. Use of episiotomy: (a) only for fetal indications and (b) in addition at a tear presumed to be imminent. Participants: 146 primiparous women with an uncomplicated singleton pregnancy at >34 weeks of gestation. For the intention‐to‐treat analysis those 109 women were included who vaginally delivered a live full‐term baby between January 1999 and September 2000: 49 women in group a, 60 in group b. Outcome measures.  Reduction of episiotomies, increase of intact perinea or only minor perineal trauma (intact perineum and first‐degree tears), third‐degree tears, anterior perineal trauma, perineal pain in the postpartum period, pH of the umbilical artery, Apgar scores, maternal blood loss. Results.  Episiotomy rates were 41% in group a and 77% in group b ( p  < 0.001). Women in the restrictive policy group had a greater chance of an intact perineum (29% vs. 10%; p  = 0.023) or only minor perineal trauma (39% vs. 13%; p  = 0.003) and had significant lower pain scores postpartum at different activities. There were no statistically significant differences with regard to third‐degree tears, anterior trauma, pre‐ and postpartum hemoglobin concentrations, Apgar scores and pH of the umbilical artery. Conclusions.  Avoiding episiotomy at tears presumed to be imminent increases the rate of intact perinea and the rate of only minor perineal trauma, reduces postpartum perineal pain and does not have any adverse effects on maternal or fetal morbidity.