@Article{, title={Whether Selective or Routine Episiotomy is more Useful to Protect Anal Sphincter in Primiparous Women}, author={Abdulrazak H. Alnakash and Shaema Jafar and Yousef Abdul-Raheem}, journal={Iraqi Postgraduate Medical Journal المجلة العراقية للاختصاصات الطبية}, volume={10}, number={4}, pages={519-525}, year={2011}, abstract={BACKGROUND:Perineal trauma is a common event, affecting up to 90% of first time mothers. It is a cause for concernfor many women and in some countries has led to a large increase in the numbers of womenrequesting elective caesarean section.OBJECTIVE:To highlight when episiotomy can be useful in preventing anal sphincter injury in primiparouswomen.MATERIALS AND METHODS:This study is a prospective interventional clinical study conducted at AL-Elwiya Maternity TeachingHospital in Baghdad throughout the period between Jan. 2009- Dec. 2009.Three hundred term primiparous ladies at time of their delivery with cephalic presentation werecollected and subdivided into 3 equal groups randomly.The first group, women who were subjected to routine mediolateral episiotomy, while the secondgroup of the participants were delivered without doing episiotomy, and the third group, a mediolateralepisiotomy was done selectively to them when we found it is necessary (selective episiotomy).State of the perineum, length of 2nd stage, weight of the baby, fetal head position and the occurrenceof anal sphincter injury were all notified and carefully recorded on special form designed for thestudy.RESULTS:Selective episiotomy was found to be more useful than routine episiotomy in preventing analsphincter injury (the incidence of anal sphincter injury was 2% for those in whom episiotomy wasperformed selectively, while it is 8% for those with routine episiotomy and 7% for those deliveredwithout episiotomy), and the difference is statistically significant (P value 0.045).There was a significant effect of the length of second stage of labour on the incidence of analsphincter injury (P value 0.017), similarly for the weight of baby (P value 0.017).CONCLUSION:Selective episiotomy is more useful intervention than routine episiotomy in protecting the analsphincter when delivering a primiparous lady.

} }