Clinical evaluation of peripartum outcomes of mediolateral versus lateral episiotomy.

OBJECTIVE To evaluate the incidence and extent of vaginal and perineal trauma among primiparous women after mediolateral and lateral episiotomy. METHODS In a prospective randomized study at University Hospital Pilsen, Czech Republic, 790 consecutive primiparous women were enrolled between April 2010 and April 2012. Mediolateral episiotomy (MLE) followed an angle of at least 60° from the midline. Lateral episiotomy (LE) started 1-2 cm laterally from the midline and was directed toward the ischial tuberosity. A rectal examination was performed before episiotomy repair. RESULTS MLE was performed for 390 women, and LE for 400. The groups did not differ in maternal or neonatal characteristics. No difference was found in incidence or extent of vaginal and perineal trauma; or in additional perineal (1.8% vs 1.5%, P=0.6) or vaginal (8.5% vs 10.6%, P=0.2) trauma continuing along the episiotomy incision. The incidence of anal sphincter injury did not differ between MLE and LE (1.5% vs 1.3%, P=0.7). MLE was associated with shorter repair times (P<0.05), less suturing material (P<0.05), and shorter distances from the anus (P<0.001). CONCLUSION Risk of additional vaginal and perineal trauma, and anal sphincter injury after adequately performed mediolateral episiotomy is relatively low and corresponds to that of lateral episiotomy.