Selective vs routine midline episiotomy for the prevention of third- or fourth-degree lacerations in nulliparous women

Am J Obstet Gynecol. 2008 Mar;198(3):285.e1-4. doi: 10.1016/j.ajog.2007.11.007. Epub 2008 Jan 25.


Objective: The purpose of this study was to determine whether selective midline episiotomy contributes to the prevention of third- or fourth-degree perineal lacerations.

Study design: A randomized controlled clinical trial was performed with 446 nulliparous women with deliveries after 28 weeks of pregnancy. Patients were randomized to undergo either routine episiotomy or selective episiotomy. In the selective episiotomy group, episiotomies were performed only in cases of imminent lacerations, fetal distress, or forceps delivery.

Results: In the group of 223 patients who underwent routine episiotomy, 32 (14.3%) had third- or fourth-degree perineal lacerations, as compared to 15 (6.8%) in the group of 222 patients undergoing selective episiotomy (relative risk, 2.12; 95% confidence interval, 1.18-3.81). Only reduction in third-degree lacerations was significant when analyzed separately. Moreover, periurethral, labia minora, and superficial vaginal lacerations were significantly more frequent in the selective episiotomy group.

Conclusion: The policy of performing selective midline episiotomy in nulliparous patients results in a reduction in the risk of third-degree perineal lacerations.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Episiotomy / methods*
  • Female
  • Humans
  • Injury Severity Score
  • Lacerations / classification
  • Lacerations / epidemiology
  • Lacerations / prevention & control*
  • Parity*
  • Pregnancy