Jaroslava Karbanova

Evaluation of the incision angle of mediolateral episiotomy at 60 degrees

To study the angle of mediolateral episiotomy at the time of cut, after primary repair, and 6 months postpartum; and the incidence and severity of perineal pain and anal incontinence 6 months after delivery.

The incision angle of mediolateral episiotomy before delivery and after repair

To assess the relevance of the suture angle when evaluating mediolateral episiotomy, and the safety of the accepted lower limit of 40° for the incision angle.

Clinical evaluation of peripartum outcomes of mediolateral versus lateral episiotomy

To evaluate the incidence and extent of vaginal and perineal trauma among primiparous women after mediolateral and lateral episiotomy.

Anal dilation during labor

To determine the incidence and range of anal dilation during the final phase of the second stage of labor and shortly after delivery; determine whether parity affects anal dilation; and obtain anthropometric data for future projects.

Stereophotogrammetry of the perineum during vaginal delivery.

To analyze deformation of the perineum during normal vaginal delivery in order to identify clinical steps that might be beneficial when executing manual perineal protection.

Angle of mediolateral episiotomy using the ischial tuberosity as a reference point

The definition of mediolateral episiotomy is based on where the incision begins, the incision angle (direction), the length, and the exact timing. According to an episiotomy survey conducted in European hospitals, 27% of responders who satisfactorily described a mediolateral episiotomy placed the direction of episiotomy toward the ischial tuberosity, or the incision midway between the center of the anus and the ischial tuberosity [1], rather than using a measurement of the angle in degrees or a clock face. Other literature also describes the ischial tuberosity as a reference point; for example, Dudenhausen and Pschyrembel [2] state that a mediolateral episiotomy begins at the midline and is directed toward the ischial tuberosity, while Beischer and MacKay [3] define the direction of a mediolateral episiotomy as “a point midway between the anus and the ischial tuberosity.” Individual episiotomies that define the incision angle in degrees or according to a clock face are easily comparable; however, descriptions that define the direction as “toward the ischial tuberosity” or “midway between the anus and ischial tuberosity” are more difficult to compare. The aim of the present study was to measure the incision angle in degrees of an episiotomy directed toward the ischial tuberosity to compare the angle with other definitions and, consequently, to assess its usefulness. Between February and September 2007 a cohort of 50 consecutive women undergoing vaginal delivery were asked to participate in the study. The women were managed by a single obstetrician during her working hours. All participants provided informed consent. The direction of episiotomy “toward the ischial tuberosity” is routinely used in our hospital and is a part of our obstetric guidelines. The main obstetric variable was the incision angle of mediolateral episiotomy. When the fetal head crowned the perineum, the ischial tuberosity was identified and the angle was measured, a mediolateral

Timing of episiotomy and outcome of a non-instrumental vaginal delivery

The aim of this study was to compare to compare immediate delivery outcome as well as healing, pain, anal incontinence and sexuality in a short‐term and a long‐term follow up after episiotomy performed before or at crowning in nulliparous women.

Mediolateral versus lateral episiotomy and their effect on postpartum coital activity and dyspareunia rate 3 and 6 months postpartum

OBJECTIVES Comparison of the effects of two episiotomy types on sexual activity, dyspareunia and overall satisfaction after childbirth. STUDY DESIGN A prospective follow-up study of a randomized comparative trial evaluating peripartum outcome of a vaginal delivery after mediolateral (MLE) or lateral (LE) episiotomy. MAIN OUTCOME MEASURES The participants completed questionnaires regarding sexual activity, dyspareunia, perineal pain, aesthetic appearance and overall satisfaction 3 (3M) and 6 months (6M) postpartum. RESULTS A total of 648 women were available for the analyses (306 MLE, 342 LE). The groups showed no difference regarding resumption and regularity of sex, timing of resumption, frequency and intensity of dyspareunia, perineal pain, aesthetic appearance or overall satisfaction 3M or 6M postpartum. 98.0% of women after MLE and 97.7% after LE resumed sexual intercourse within 6M after delivery (p = 0.74). In the same period 15.6% of women after MLE and 16.1% after LE suffered from considerable dyspareunia (p = 0.86). CONCLUSIONS Quality of sexual life and perception of perineal pain after MLE is equivalent to LE.

Clinical evaluation of early postpartum pain and healing outcomes after mediolateral versus lateral episiotomy

To evaluate short‐term perineal pain among primiparous women after mediolateral episiotomy (MLE) and lateral episiotomy (LE).

Anal incontinence and fecal urgency following vaginal delivery with episiotomy among primiparous patients

To investigate anal incontinence following mediolateral or lateral episiotomy during a first vaginal delivery.