Comparison between two incision angles of mediolateral episiotomy in primiparous women: A randomized controlled trial

Aim To compare two incision angles (60° vs 40°) of mediolateral episiotomy in primiparous E gyptian women, regarding the incidence of anal sphincter injury as well as episiotomy‐related pain and dyspareunia. Methods The current prospective randomized controlled trial ( C linical T rials.gov, NCT 01930721) was conducted at A in S hams U niversity M aternity H ospital. Eligible women were randomized into two groups: group 1 included women who had the episiotomy incision made at an angle of 60° to the midline; and group 2 included women who had the episiotomy incision made at an angle of 40° to the midline. Primary outcome measures were differences in short‐term related pain and rate of third/fourth degree perineal tears. Results A total of 330 primiparous women were recruited. The shortest distance to the outer edge of the anal epithelium was significantly shorter in women of group 2 when compared to that in women of group 1. Out of the included 330 women, 13 (4%) had third/fourth‐degree perineal tears (4 [2.4%] in group 1 in contrast to nine [5.5%] in group 2). This difference was not significant A 60°‐angled mediolateral episiotomy was associated with significantly higher rates of moderate/severe episiotomy‐related pain post‐partum. The rates of moderate/severe episiotomy‐related pain and dyspareunia assessed 6 months post‐partum were also higher among women of group 1, when compared to group 2; the latter two differences did not reach statistical significance, however. Conclusion When compared to the 40°‐angled mediolateral episiotomies, 60°‐angled ones were associated with significantly higher short‐term‐related pain. Although they were also associated with lower rate of third/fourth‐degree perineal tears and higher rate of long‐term related pain and dyspareunia, these differences did not reach a statistically significant level.