Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Gynaecology and Obstetrics

Episiotomy is the surgical incision of the vaginal orifice and perineum to ease the passage of an infant{u2019}s head while crowning during vaginal delivery. Episiotomy remains one of the most commonly performed surgeries around the world, although routine episiotomy has been on the decline since guidelines from multiple obstetric societies recommended against its use, citing insufficient evidence of its efficacy. (American College of Obstetricians and Gynecologists, 2016). However, episiotomy remains an important part of the obstetrician{u2019}s toolkit (even in the United States) during emergencies of fetal distress in the presence of a tight maternal perineum, especially in the case of shoulder dystocia. (Sagi-Dain, L. et al., 2015).Episiotomy is performed on an individualized basis. Episiotomy is considered when the clinical circumstances place the patient at high risk of a third or fourth degree laceration or when the fetal heart tracing is of concern and hastening vaginal delivery is warranted. Mediolateral episiotomy is associated with a lower risk of third and fourth degree laceration than a median episiotomy. (Bhuria,et al., 2013).A clear and controlled incision is easy to repair and heals better than a lacerated wound that might occur otherwise, Reduction in the duration of second stage, Reduction of trauma to the pelvic floor muscles, Minimal bleeding than lacerated wound, less pain in the postpartum period, Incidence of dyspareunia is less and Prevention of prolonged and overstretch of the perineum which predispose to prolapse and stress incontinence.(Robinson et al., 2013)

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