חיתוך חיץ-הנקביים - הערכה מחודשת

BACKGROUND: Since episiotomy was first introduced in the 18th century its popularity has expanded. Today, the majority of first deliveries in Israel are estimated to include an episiotomy. The benefits traditionally ascribed to episiotomy include prevention of perineal damage and its sequelae, prevention of pelvic floor relaxation and its sequelae, and protection of the newborn from either intracranial hemorrhage or intrapartum asphyxia. METHODS: We reviewed the English language literature published in the last twenty years concerning this issue. We emphasized sources that included prospective randomized controlled trials. RESULTS: Episiotomy prevents anterior perineal lacerations (which carry minimal morbidity), but fails to accomplish any of the other fetal or maternal benefits. On the other hand, the incision substantially increases maternal blood loss, the length and depth of posterior perineal injury and the risk of anal injury. CONCLUSION: Based on the currently available information, routine episiotomy is no longer advisable. Its incidence must be gradually lowered.