A study of the morbidity associated with episiotomy

Objective: To review the indications and the morbidity associated with episiotomy. Methods: Study was carried out in 450 consecutive women who had episiotomies at delivery during the period from 01-03-2002 to 01-09-2002 at University Unit, Colombo South Teaching Hospital. Women were interviewed within 24 hours of delivery and 6 weeks later. Data were collected using an interviewer administered questionnaire. Results: Out of a total of 876 mothers 51.4% had episiotomies at delivery and in 87% the indication was prevention of a possible perineal laceration. In 8% of women episiotomy was sutured later than 30 minutes from the time of performing. Although 10 ml of 1% lignocaine was infiltrated before performing and suturing the episiotomy, 80% of women complained of moderate to severe pain while performing the incision and 73% complained of moderate to severe pain during suturing. When seen six weeks later, 5% of patients complained of perineal pain and only 0.4 % had dyspareunia. Conclusion: Although episiotomy is generally considered to be a harmless procedure it causes moderate to severe pain in a majority of women. Adequate local analgesia, use of less-reactive suture material, emphasis on immediate suturing and post-partum analgesics may contribute to reduce the pain suffered by women following episiotomy.