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Textbook recommendations for preventing and treating perineal injury at vaginal delivery.

Stepp KJ, Siddiqui NY, Emery SP, Barber MD

Department of Obstetrics and Gynecology, the Cleveland Clinic Foundation, OH 44109, USA. kstepp@metrohealth.org

OBJECTIVE: To assess general obstetrics textbooks regarding the quality and quantity of information about perineal injury at vaginal delivery. METHODS: An obstetrics and gynecology resident, a perinatologist, and a urogynecologist evaluated 7 obstetrics textbooks by using a standardized abstraction form that delineated descriptions of anatomy and physiology, episiotomy use, and perineal trauma prevention and repair. RESULTS: Two textbooks briefly described anal sphincter anatomy, but none provided a detailed discussion of the relative contribution of anatomic components to continence. Four textbooks discussed the evidence for and against midline or mediolateral episiotomy, and 6 advised against routine episiotomy. Six textbooks described grading lacerations, but only one described detailed repair techniques for all grades. Two textbooks discussed techniques to reduce perineal trauma at the time of delivery. Only one textbook discussed the need to reapproximate the normal anal sphincter anatomy during perineal repair. CONCLUSION: Although most textbooks accurately reflect current literature regarding routine episiotomy, there is limited discussion of advantages and disadvantages of various types of episiotomy and little offered regarding prevention and repair of perineal trauma at delivery. LEVEL OF EVIDENCE: III.

Published 1 February 2006 in Obstet Gynecol, 107(2): 361-6.
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