We have two special guests on the podcast this week: Paul Jones and Dan Finnigan are Canadian family doctors with extra training in emergency and obstetrics.
The guys have created a mobile obstetric app called “Simply Obstetrics”. Check it out here. In part one of the podcast we discuss the perils of rural and remote obstetrics and how the app can come in handy for those isolated or “occasional” birth attendants.
In part two we get into the meaty clinical topic of episiotomies and protection of the perineum.
Our top take home messages:
- Episiotomies should be used selectively not routinely, as the use of routine episiotomy results in increased risk of major sphincter injury
- The mediolateral approach is associated with less risk of sphincter injury compared to midline approach
- The threshold for cutting an episiotomy should be much lower with instrumental deliveries, particularly forceps (NNT = 7)
- We prefer the use of “hands on” technique for delivery, with controlled delivery of the fetal head and warm compresses to the perineum
References & Resources
Dixon, O&G Magazine (Autumn 2014) – The Unkindest Cut?
Eogan et al, BJOG (Feb 2006) – Does the Angle of Episiotomy Affect the Incidence of Anal Sphincter Injury?
Jansova et al, International Urogynecology Journal (September 2014) – Modeling Manual Perineal Protection During Vaginal Delivery