From the Guidelines
A surgical incision of the labia to facilitate delivery of a macrosomic fetus is specifically referred to as a mediolateral episiotomy or a perineal incision with labial extension. This type of incision is made to increase the diameter of the vulvar outlet and facilitate delivery, as described in the American Journal of Obstetrics and Gynecology 1. The American College of Obstetricians and Gynecologists (ACOG) defines two main types of episiotomies, including midline and mediolateral episiotomies, with the latter being directed laterally at an angle of at least 60 degrees from the midline toward the ischial tuberosity 1.
- Key characteristics of a mediolateral episiotomy include:
- Starting within 3 mm of the midline in the posterior fourchette
- Directed laterally at an angle of at least 60 degrees from the midline
- Extending toward the ischial tuberosity In the context of delivering a macrosomic fetus, a mediolateral episiotomy or a perineal incision with labial extension may be necessary to facilitate delivery and prevent severe perineal trauma, as noted in the guidelines for perineal trauma after vaginal delivery 1.
From the Research
Definition of Episiotomy
- Episiotomy is a surgical incision of the perineum and the posterior vaginal wall in the second stage of labour 2, 3, 4, 5, 6
- It is performed to widen the vaginal opening and facilitate the birth of an infant 2, 3, 4, 5, 6
Indications for Episiotomy
- Episiotomy may be performed to facilitate the delivery of a macrosomic fetus 5
- Other indications for episiotomy include instrumental delivery, prolonged second-stage labor, and fetal birth weight >3,000 grams 5
Types of Episiotomy
- Midline episiotomy: a surgical incision of the perineum in the midline 3, 6
- Mediolateral episiotomy: a surgical incision of the perineum at an angle to the midline 3, 6