Proper use of episiotomy in modern obstetrics

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Elliot M. Levine

Illinois Masonic Medical Center, USA

: Androl Gynecol: Curr Res

Abstract

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Objective: A comparison was made of episiotomy rates and the rates of advanced perineal lacerations (APL) between different modern times, in order to view the likely consequences of performing episiotomy at vaginal delivery, and to consider applying this to obstetric quality standards. Study Design: A Structured Query Language (SQL) perinatal database, used in a community hospital, was used to investigate the prevalence of episiotomy performed at vaginal delivery and the incidence of APL, for a comparison between different time periods. The type of obstetric provider, the type of episiotomy if performed, any associated operative procedures, neonatal birth weight and Apgar scores, estimated blood loss, and other obstetric variables were reviewed. Results: The average episiotomy rate steadily declined from 1996-1998, 2003-2005 and 2012-2014. The rate of advanced perineal lacerations coincidentally rose during these time period comparisons. Conclusion: Obstetric providers may need to consider the likely outcome at vaginal delivery when considering to perform an episiotomy. Quality standards may need to more properly focus on the incidence of APL, rather than the episiotomy rate, given the clinical data that the authors examined.

Biography

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Elliot M. Levine received his Bachelor of Science from the University of Wisconsin at Madison in 1974 and his MD from the Chicago Medical School in 1978 and completed his Residency in Obstetrics and Gynecology at Illinois Masonic Medical Center in 1982. He has been Board Certified in Obstetrics & Gynecology continuously since 1984. He is a member of a number of medical societies including the American College of Obstetricians and Gynecologists, the Chicago Gynecological Society, the Central Association of Obstetricians and Gynecologists, and the American Medical Informatics Association, to name a few. His involvement in research, education and Quality Assurance has allowed him to author numerous articles in medical journals, leading him to often lecture to physician audiences. He has served as Director of Informatics and Research in a Department of Obstetrics & Gynecology for well over a decade and as a Physician Director for the implementation of an Electronic Medical Record System in a large healthcare system. He continues to have a general gynecology practice, and has been listed in America’s Top Doctors for over a decade