Chouksey Richa, Veluguleti Sai Snehitha, Pandey Deeksha
Department of Obstetrics and Gynaecology, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India.
Department of Obstetrics and Gynaecology, Post Doctoral Fellow in Urogynaecology, Krishna Institute Of Medical Sciences, Secunderabad, India.
Eur J Obstet Gynecol Reprod Biol X. 2025 Jul 5;27:100418. doi: 10.1016/j.eurox.2025.100418. eCollection 2025 Sep.
Episiotomy, though simple and most common surgical procedure performed in labour theatre, has a lot of bearing on patients' recovery postpartum. The episiotomy angle and length can influence probability of anal sphincter trauma, ease of delivery and post-delivery recovery in variable ways. We hypothesize that a universal measure of angle (60°) and length might not be ideal for all women. This aim of this cohort study was to establish association of episiotomy trigonometric characteristics (length and angle) with antepartum, intrapartum and postpartum factors.
MATERIAL & METHODS: A total of 504 pregnant women who delivered with an episiotomy after 34 weeks of gestation were included. Antenatal, intrapartum, and postpartum variables were collated. These women were examined for episiotomy length, angle, signs of infection/inflammation and pain using Visual Analogue Scale (VAS). All of them were followed up till they were discharged frm the hospital.
A smaller episiotomy angle (<15°) was associated with significantly higher VAS score as compared to angle 35°-40°. We observed that as birth weight increases, mean episiotomy length and angle progressively increases. Longer head circumference was associated with longer length of episiotomies (p < 0.01). Instrumental deliveries were associated with higher length and angle of episiotomy.
We observed a relationship of trigonometric characteristics of episiotomy with variables like birth weight and HC. We feel the angle and length of episiotomy cannot be defined as a universal constant. It depends of maternal and fetal variables. We propose that episiotomy should be tailored for every patient to achieve the most optimal result for her.
This study reflects episiotomy practice at a tertiary care hospital. We must conduct larger studies to evaluate variables that influence the trigonometric characteristics of episiotomy.
会阴切开术虽是产房里实施的简单且最常见的外科手术，但对患者产后恢复有很大影响。会阴切开术的角度和长度会以多种方式影响肛门括约肌损伤的可能性、分娩的难易程度及产后恢复情况。我们推测，统一的角度（60°）和长度测量标准可能并非对所有女性都理想。本队列研究的目的是确定会阴切开术的三角学特征（长度和角度）与产前、产时及产后因素之间的关联。
纳入了总共504名妊娠34周后行会阴切开术分娩的孕妇。整理了产前、产时及产后变量。使用视觉模拟评分法（VAS）对这些女性进行会阴切开术长度、角度、感染/炎症迹象及疼痛检查。对所有患者进行随访直至出院。
与35° - 40°的角度相比，较小的会阴切开术角度（<15°）与显著更高的VAS评分相关。我们观察到，随着出生体重增加，会阴切开术的平均长度和角度逐渐增加。头围较长与会阴切开术长度较长相关（p < 0.01）。器械助产与会阴切开术的长度和角度较大相关。
我们观察到会阴切开术的三角学特征与出生体重和头围等变量之间存在关联。我们认为会阴切开术的角度和长度不能定义为一个通用常数。它取决于母体和胎儿变量。我们建议应为每位患者量身定制会阴切开术，以实现对其最优化的结果。
本研究反映了一家三级护理医院的会阴切开术实践情况。我们必须开展更大规模的研究来评估影响会阴切开术三角学特征的变量。
