Bilquees Parveen, Gulfi Shan Haq, Aneela Sheikh.
Routine versus selective episiotomy in primigravidae.
Pak J Surg Jan ;28(4):285-90.

Objectives: To compare maternal morbidity in routine versus selective episiotomy in primigravidae. Study design: Quasi-experimental. Sett ing and duration of study: Obstetrics and Gynae/ Obs unit-ll of civil hospital Karachi from September 14, 2007 to March 14, 2008. Methodology: Two interventions compared were selective (limited to specifi ed maternal or fetal indications) and routine episiotomy (following the hospital policy). Hundred primigravidae were included as 50 women in each group. Th e main outcome measures which causes maternal morbidity was severe perineal trauma (3rd and 4th degree tears). Other outcomes which cause the maternal morbidity in terms of 1st and 2nd perineal tears, presence of perineal pain, haematoma formation, wound dehiscence and wound infection were also recorded on proforma. Results: Th e study includes 50 women of routine episiotomy and 50 women of elective episiotomy by following maternal and/ or fetal indications, 14 (28%) women were given episiotomy while 36 (72%) were not given. Overall mean age of 100 women was 26.97 ± 1.84 (ranging from 24 to 30) years. Majority (44%) of women in both groups had gestational age of 38 weeks. Second degree tear was seen signifi cantly higher in routine episiotomy groups (74% vs. 44%, p=0.002). On 1st postnatal day, proportion of perineal pain was signifi cantly higher in routine episiotomy group than selective episiotomy group (92% vs. 48%). Conclusion: As perineal pain, haematoma formation and wound dehiscence’, wound infections were all less frequent in selected group, as compare to routine group, so maternal morbidity reduced.

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