Episiotomie

Die Geburt als physiologischer Vorgang sollte grundsätzlich möglichst ohne medizinische Interventionen erfolgen. Im Mittelpunkt dieser Überlegung steht insbesondere die weltweit häufig durchgeführte Episiotomie. Sie ist – trotz nur weniger wissenschaftlicher Daten – eine der häufigsten geburtshilflichen Operationen. Eine Sichtung der aktuellen Literatur rechtfertigt eine äußerst zurückhaltende Empfehlung zur Episiotomie in der klinischen Routine.

Kernaussagen

• Die Episiotomie ist – trotz weitreichend fehlender wissenschaftlicher Daten – eine der häufigsten geburtshilflichen Operationen.

• Die Episiotomie hat jedoch Risikofaktoren.

• Sie trägt zur Protektion des Beckenbodens bei und verringert die postpartale Urin- und Analinkontinenz.

• Die Episiotomie ermöglicht eine Verbesserung des sexuellen Erlebens Jahre nach der vaginalen Entbindung.

• Die Episiotomie verringert die kindliche Morbidität, insbesondere bei Frühgeburt.

Schlüsselwörter

Episiotomie - Indikation - Komplikation - Protektion des Beckenbodens

• Literatur

• 1 Jiang H, Qian X, Carroli G. et al. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev 2017; (02) CD000081
• 2 Schantz C, Sim KL, Ly EM. et al. Reasons for routine episiotomy: A mixed-methods study in a large maternity hospital in Phnom Penh, Cambodia. Reprod Health Matters; 2015; 23: 68-77 doi:10.1016/j.rhm.2015.06.012
• 3 Naidu M, Kapoor DS, Evans S. et al. Cutting an episiotomy at 60 degrees: how good are we?. Int Urogynecol J 2015; 26: 813-816 doi:10.1007/s00192-015-2625-9
• 4 Schünke M, Schulte E, Schumacher U. Hrsg. PROMETHEUS Allgemeine Anatomie und Bewegungssystem. Stuttgart: Thieme; 2018
• 5 Thacker SB, Banta HD. Benefits and risks of episiotomy: an interpretative review of the English language literature, 1860–1980. Obstet Gynecol Surv 1983; 38: 322-338
• 6 David M, Ebert A. Medizinhistorische Anmerkungen zur Einführung und Verbreitung der Episiotomie. Geburtshilfe Frauenheilkd 2017; 77: 41-44 doi:10.1055/s-0042-123032
• 7 Myers-Helfgott MG, Helfgott AW. Routine use of episiotomy in modern obstetrics. Should it be performed?. Obstet Gynecol Clin North Am 1999; 26: 305-325
• 8 Hirsch HA, Neeser E. Episiotomie und Dammriß. Stuttgart: Thieme; 1989
• 9 Stones RW, Paterson CM, Saunders NJ. Risk factors for major obstetric haemorrhage. Eur J Obstet Gynecol Reprod Biol 1993; 48: 15-18
• 10 Fodstad K, Staff AC, Laine K. Effect of different episiotomy techniques on perineal pain and sexual activity 3 months after delivery. Int Urogynecol J 2014; 25: 1629-1637 doi:10.1007/s00192-014-2401-2
• 11 Sagi-Dain L, Sagi S. Indications for episiotomy performance – a cross-sectional survey and review of the literature. J Obstet Gynaecol 2016; 36: 361-365 doi:10.3109/01443615.2015.1065233
• 12 Sagi-Dain L, Sagi S. The correct episiotomy: does it exist? A cross-sectional survey of four public Israeli hospitals and review of the literature. Int Urogynecol J 2015; 26: 1213-1219 doi:10.1007/s00192-015-2680-2
• 13 Gonzalez-Díaz E, Fernández Fernández C, Fernández Corona A. Differences in characteristics of mediolateral episiotomy in professionals at the same hospital. J Matern Fetal Neonatal Med 2016; 29: 2368-2372 doi:10.3109/14767058.2015.1086328
• 14 Kaddoura R, DeJong J, Zurayk H. et al. Episiotomy practice in the Middle East: A Lebanese teaching tertiary care center experience. Women Birth 2019; 32: e223-e228 doi:10.1016/j.wombi.2018.07.005
• 15 Kopeć-Godlewska K, Pac A, Różańska A, Wójkowska-Mach J. Is vaginal birth without an episiotomy a rarity in the 21st century? Cross-sectional studies in Southern Poland. Int J Environ Res Public Health 2018; 15: E2462 doi:10.3390/ijerph15112462
• 16 Goueslard K, Cottenet J, Roussot A. et al. How did episiotomy rates change from 2007 to 2014? Population-based study in France. BMC Pregnancy Childbirth 2018; 18: 208 doi:10.1186/s12884-018-1747-8
• 17 Shmueli A, Gabbay Benziv R, Hiersch L. et al. Episiotomy – risk factors and outcomes. J Matern Fetal Neonatal Med 2017; 30: 251-276 doi:10.3109/14767058.2016.1169527
• 18 Cromi A, Bonzini M, Uccella S. et al. Provider contribution to an episiotomy risk model. J Matern Fetal Neonatal Med 2015; 28: 2201-2206 doi:10.3109/14767058.2014.982087
• 19 Howden NLS, Weber AM, Meyn LA. Episiotomy use among residents and faculty compared with private practitioners. Obstet Gynecol 2004; 103: 114-118 doi:10.1097/01.AOG.0000103997.83468.70
• 20 Martin DL. The protection of the perineum by episiotomy in delivery at term. Cal State J Med 1921; 19: 229-231
• 21 Klein MC, Gauthier RJ, Robbins JM. et al. Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation. Am J Obstet Gynecol 1994; 171: 591-598
• 22 Sartore A, De Seta F, Maso G. et al. The effects of mediolateral episiotomy on pelvic floor function after vaginal delivery. Obstet Gynecol 2004; 103: 669-673 doi:10.1097/01.AOG.0000119223.04441.c9
• 23 Woolley RJ. Benefits and risks of episiotomy: a review of the English-language literature since 1980. Part I. Obstet Gynecol Surv 1995; 50: 806-820
• 24 Woolley RJ. Benefits and risks of episiotomy: a review of the English-language literature since 1980. Part II. Obstet Gynecol Surv 1995; 50: 821-835
• 25 Oliveira DA, Parente MPL, Calvo B. et al. A biomechanical analysis on the impact of episiotomy during childbirth. Biomech Model Mechanobiol 2016; 15: 1523-1534 doi:10.1007/s10237-016-0781-6
• 26 Kwon HY, Park HS. Episiotomy and the risk of severe perineal injuries among Korean women. J Matern Fetal Neonatal Med 2017; 30: 1745-1749 doi:10.1080/14767058.2016.1224833
• 27 Laganà AS, Terzic M, Dotlic J. et al. The role of episiotomy in prevention of genital lacerations during vaginal deliveries – results from two European centers. Ginekol Pol 2015; 86: 168-175
• 28 Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database Syst Rev 2009; (01) CD000081
• 29 Pergialiotis V, Vlachos D, Protopapas A. et al. Risk factors for severe perineal lacerations during childbirth. Int J Gynaecol Obstet 2014; 125: 6-14 doi:10.1016/j.ijgo.2013.09.034
• 30 Yamasato K, Kimata C, Huegel B. et al. Restricted episiotomy use and maternal and neonatal injuries: a retrospective cohort study. Arch Gynecol Obstet 2016; 294: 1189-1194
• 31 Sulaiman AS, Ahmad S, Ismail NAM. et al. A randomized control trial evaluating the prevalence of obstetrical anal sphincter injuries in primigravida in routine versus selective mediolateral episiotomy. Saudi Med J 2013; 34: 819-823
• 32 Fritel X, Schaal JP, Fauconnier A. et al. Pelvic floor disorders 4 years after first delivery: a comparative study of restrictive versus systematic episiotomy. BJOG 2008; 115: 247-252
• 33 Verghese TS, Champaneria R, Kapoor DS. et al. Obstetric anal sphincter injuries after episiotomy: systematic review and meta-analysis. Int Urogynecol J 2016; 27: 1459-1467
• 34 Sagi-Dain L, Sagi S. Morbidity associated with episiotomy in vacuum delivery: a systematic review and meta-analysis. BJOG 2015; 122: 1073-1081 doi:10.1111/1471-0528.13439
• 35 Chayachinda C, Titapant V, Ungkanungdecha A. Dyspareunia and sexual dysfunction after vaginal delivery in Thai primiparous women with episiotomy. J Sex Med 2015; 12: 1275-1282 doi:10.1111/jsm.12860
• 36 Doğan B, Gün İ, Özdamar Ö. et al. Long-term impacts of vaginal birth with mediolateral episiotomy on sexual and pelvic dysfunction and perineal pain. J Matern Fetal Neonatal Med 2017; 30: 457-460
• 37 Sagi-Dain L, Sagi S. The role of episiotomy in prevention and management of shoulder dystocia: a systematic review. Obstet Gynecol Surv 2015; 70: 354-362 doi:10.1097/OGX.0000000000000179
• 38 Bottoms S. Delivery of the premature infant. Clin Obstet Gynecol 1995; 38: 780-789
• 39 Alperin M, Krohn MA, Parviainen K. Episiotomy and increase in the risk of obstetric laceration in a subsequent vaginal delivery. Obstet Gynecol 2008; 111: 1274-1278 doi:10.1097/AOG.0b013e31816de899