The relationship of episiotomy to third and fourth degree lacerations.

Third and fourth degree lacerations can produce significant long term morbidity to women undergoing childbirth. The incidence of third and fourth degree lacerations is variable depending on the institution and the obstetrical provider. While episiotomy remains a valuable intervention in selected cases, an improvement program directed at lowering the use of episiotomy can reduce the incidence of this clinical event. Hospitals and physicians with higher rates of third and fourth degree tears should examine the use of episiotomy, and midline episiotomy in particular, which is associated with an increased incidence of third and fourth degree tears.