OBSadvanced
What is the recommended standard of practice regarding the use of episiotomy during vaginal delivery, and when is its performance justified?
Answer
The recommended practice is selective (restrictive) episiotomy rather than routine use. It is justified only when there is a specific maternal or fetal indication, such as facilitating operative vaginal delivery or an obstetric manoeuvre (e.g., shoulder dystocia), expediting delivery for non-reassuring fetal status, or when severe perineal tearing is imminent.
Explanation
The scenario includes two possible indications in the supplied material: a perineum threatening to tear badly, especially if rigid, and the need for room for selected obstetric manoeuvres. However, the lecture also emphasizes avoiding episiotomy where possible. Therefore, the findings support consideration rather than automatic use; a valid indication and appropriate procedural preparation remain necessary.\n\n**Key takeaway:** Clinical findings may justify selective episiotomy, but they do not make it routine.\n\n**Glossary:** **Selective episiotomy**: Incision performed only for a suitable indication; **perineal rigidity**: Reduced ability of perineal tissues to stretch.
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