Editor- I am surprised at the somewhat irresponsible reference to
episiotomies in the editorial (1) in this week's BMJ. It has long been
known that ill-performed episiotomies may increase the risk of anal
sphincter
damage, amongst other things. The article to which you refer (2) evaluates
retrospectively the relation between midline episiotomy and postpartum
anal incontinence. The paper does not describe the episiotomy technique
used in any detail. I am unaware of any obstetrician in this country, at
least, who would perform a midline (rather than a mediolateral) episiotomy
- for exactly this reason.
Like you, I have repaired many episiotomies (sleepily or otherwise) and
have since been trained in the application of healthy scepticism to
practice.
You assert that episiotomy (midline) may not be a beneficial procedure. I
am surprised that you do not back this assertion with evidence. There has
been plenty published. Surely someone has done a systematic review on the
benefit
(or otherwise) of episiotomy- midline or otherwise?
1 editorial BMJ 080100
2 Signorello SB, Harlow BL, Chekos AK & Repke JT Midline
episiotomy and anal incontinence: retrospective cohort study. BMJ 2000;
320: 86-90.
Imogen Stephens
Consultant in Public Health Medicine
Argyll & Clyde Health Board,
Ross House,
Paisley
PA2 7BN.
Rapid Response:
episiotomies
Editor- I am surprised at the somewhat irresponsible reference to
episiotomies in the editorial (1) in this week's BMJ. It has long been
known that ill-performed episiotomies may increase the risk of anal
sphincter
damage, amongst other things. The article to which you refer (2) evaluates
retrospectively the relation between midline episiotomy and postpartum
anal incontinence. The paper does not describe the episiotomy technique
used in any detail. I am unaware of any obstetrician in this country, at
least, who would perform a midline (rather than a mediolateral) episiotomy
- for exactly this reason.
Like you, I have repaired many episiotomies (sleepily or otherwise) and
have since been trained in the application of healthy scepticism to
practice.
You assert that episiotomy (midline) may not be a beneficial procedure. I
am surprised that you do not back this assertion with evidence. There has
been plenty published. Surely someone has done a systematic review on the
benefit
(or otherwise) of episiotomy- midline or otherwise?
1 editorial BMJ 080100
2 Signorello SB, Harlow BL, Chekos AK & Repke JT Midline
episiotomy and anal incontinence: retrospective cohort study. BMJ 2000;
320: 86-90.
Imogen Stephens
Consultant in Public Health Medicine
Argyll & Clyde Health Board,
Ross House,
Paisley
PA2 7BN.
Competing interests: No competing interests