The impact of super-selective episiotomy on maternal short-term morbidity

Purpose: Our aim is to investigate the risk of short-term maternal morbidity caused by super-selective clinical use of episiotomies (rate of below 0.02). A secondary aim is to compare our risk of severe perineal tears to the state-wide risk. Methods: This is a retrospective cohort study investigating the effect of super-selective episiotomy on the risk of severe perineal tears and blood loss. Results: The study included 10992 women who delivered between 2008-2018. Episiotomies were performed in 171 cases (1.56%), 3 of which (1.75%) experienced severe perineal tears compared to 156 (1.44%) in the control cohort. The adjusted odds ratio of severe perineal tears was 0.99 (0.95 CI 0.30, 3.26 p-value 0.98). Multivariate linear regression showed that episiotomies increased blood loss by 77.47 ml (0.95 CI 34.34, 120.59 p-value <0.0001). Episiotomies were performed in 23% (0.95 CI 0.228, 0.23) of vaginal deliveries in the state of Hessen with a risk of severe perineal tears of 0.0143 (0.95 CI 0.0139, 0.0147) compared to 0.0145 (0.95 CI 0.0123, 0.0168) in our entire cohort. Conclusion: Institutionally implemented super-selective use of episiotomy does not increase the risk of higher-grade perineal tears but leads to increased blood loss. Therefore, episiotomies potentially increase maternal morbidity.