Abstract
Episiotomy is a surgical incision to the perineum made during the last part of labour to facilitate delivery. It should always be defined by the location of the beginning, direction, length, and timing.
Seven episiotomy types have been identified. However, only three (midline, mediolateral, and lateral) are routinely used.
Exact placement of episiotomy incision is significant regarding perineal trauma. Lateralisation of episiotomies significantly decreased OASIS incidence.
While midline episiotomy increases the risk of OASIS, the protective role of mediolateral episiotomy depends on the correct identification of the risk group and correct incision. A protective effect of lateral episiotomy on primiparous women has been consistently demonstrated.
Mediolateral episiotomy at an angle of at least 60o from the midline or lateral episiotomy are recommended. A restrictive policy regarding episiotomy is recommended: <30% in total, <50% for primiparas, <10% in multiparas.
Episiotomy is clearly indicated for fetal compromise, and, consensually, instrumental deliveries. Perineal mapping is helpful in deciding whether episiotomy might be useful.
A qualified approach to the protection of the perineum should be applied to all deliveries including those with episiotomy. A continuous non-locking suturing technique for all layers using fast-absorbing synthetic material is currently the recommended standard for episiotomy repair.