Perineal Trauma and Episiotomy

  • Dharmesh S. Kapoor
  • Abdul H. SultanEmail author


Perineal trauma affects 80% of women during parturition with nearly 50% requiring suturing. All clinicians practicing obstetrics should be trained in accurately diagnosing and classifying perineal trauma and rectal examination is an integral component of management. An episiotomy is a grade 2 perineal tear and is an incision made to enlarge the vaginal outlet to facilitate delivery of the foetus. This should be mediolateral to avoid injury to the anal sphincter. Clear guidance is provided on the indications for an episiotomy and the technique to be adopted.


Episiotomy 60 degree angled mediolateral episiotomy Obstetric anal sphincter injuries Perineal tears Perineal trauma 


Conflicts of Interest

DS Kapoor is a co-inventor of the EPISCISSORS-60 episiotomy scissors. He is a shareholder of MEDINVENT LTD, the company that owns the commercial rights to the scissors.

AH Sultan-none.


  1. 1.
    Ten Years of Maternity Claims: An Analysis of NHS Litigation Authority Data. ISBN: 978–0–9565019-2-9.
  2. 2.
    Sultan AH, Thakar R, Fenner D. Perineal and anal sphincter trauma. London: Springer; 2007. p. 13–32.Google Scholar
  3. 3.
    RCOG Greentop guideline 29: the management of third and fourth-degree perineal tears: RCOG June 2015,
  4. 4.
    Intrapartum care. National Institute of Health and Care Excellence (2014), [CG190]. London:
  5. 5.
    Kalis V, Landsmanova J, Bednarova B, Karbanova J, Laine K, Rokyta Z. Evaluation of the incision angle of mediolateral episiotomy at 60 degrees. Int J Gynecol Obstet. 2011;112:220–4.CrossRefGoogle Scholar
  6. 6.
    El-Din AS, Kamal MM, Amin MA. Comparison between two incision angles of mediolateral episiotomy in primiparous women: a randomised controlled trial. J Obstet Gynaecol Res. 2014;40:1877–82.CrossRefPubMedGoogle Scholar
  7. 7.
    Freeman RM, Hollands H, Barron L, Kapoor DS. Cutting a Mediolateral Episiotomy at the Correct Angle: Evaluation of a new device: The Episcissors-60. Med Devices (Auckl). 2014;7:23–8. Scholar
  8. 8.
    Sawant G, Kumar D. Randomized trial comparing episiotomies with Braun-Stadler episiotomy scissors and EPISCISSORS-60(®). Med Devices (Auckl). 2015;8:251–4. Scholar
  9. 9.
    Eogan M, Daly L, O’Connell PR, O’Herlihy C. Does the angle of episiotomy affect the incidence of anal sphincter injury? BJOG. 2006;113:190–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Stedenfeldt M, Pirhonen J, Blix E, Wilsqaard T, Vonen B, Qian P. Episiotomy characteristics and risks for obstetric anal sphincter injury: a case-control study. BJOG. 2012;119:724–30.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Evidence Based Guidelines for Midwifery-Led Care in Labour ©The Royal College of Midwives 2012.Google Scholar
  12. 12.
    Sultan AH, Ritchie A, Mooney G. Obstetric anal sphincter injuries: Review of recent medico-legal aspects. Clinical Risk. 2016;0(0):1–4. Scholar
  13. 13.
    Gurol-Urganci I, Cromwell D, Edozien L, Mahmood T, Adams E, Richmond D, Templeton A, van der Meulen J. Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors. BJOG. 2013;120:1516–25.CrossRefPubMedGoogle Scholar
  14. 14.
    Verghese TS, Champaneria R, Kapoor DS, Latthe PM. Obstetric anal sphincter injuries after episiotomy: systematic review and meta-analysis. Int Urogynecol J. 2016;27(10):1459–67. Epub 2016 Feb 19.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Jiang H, Qian X, Carroli G, Garner P. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev. 2017;(2):CD000081.Google Scholar
  16. 16.
    Andrews V, Thakar R, Sultan AH, Jones PW. Are mediolateral episiotomies actually mediolateral? BJOG. 2005;112(8):1156.CrossRefPubMedGoogle Scholar
  17. 17.
    Andrews V, Thakar R, Sultan AH, Jones PW. Occult anal sphincter injuries—myth or reality? BJOG. 2006;113:195–200.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Royal Bournemouth HospitalDorsetUK
  2. 2.Croydon University HospitalCroydonUK

Personalised recommendations