From the Guidelines
Episiotomy is not considered a risk factor for cervical laceration because it involves a different anatomical structure that does not directly affect the cervix. The procedure of episiotomy, as described in the study by 1, involves making an incision in the perineum to increase the diameter of the vulvar outlet, which is distinct from the cervical area. According to the study published in the American Journal of Obstetrics and Gynecology in 2024 1, the perineum extends from the pubic arch to the coccyx and is divided into the anterior urogenital and posterior anal triangles, whereas the cervix is located at the lower end of the uterus.
The key points to consider are:
- The anatomical difference between the perineum and the cervix, as outlined in the study 1
- The timing of episiotomy, which occurs during the second stage of labor when the cervix is already fully dilated, minimizing the risk of cervical injury from the procedure itself
- The definition and diagnosis of perineal trauma, including episiotomy, as standardized by the American College of Obstetricians and Gynecologists (ACOG) in 2012, which does not imply a direct relationship with cervical lacerations 1
Given this information, it is clear that episiotomy and cervical laceration are unrelated in terms of risk factors, as they involve different parts of the female reproductive system and the procedure of episiotomy does not directly impact the cervix.
From the Research
Risk Factors for Cervical Laceration
- Cervical lacerations can occur during vaginal birth, but the provided studies do not directly link episiotomy as a risk factor for cervical laceration 2, 3.
- The studies focus on the prevention and management of obstetric lacerations, including those that occur on the cervix, vagina, and vulva, but do not specifically address episiotomy as a risk factor for cervical laceration.
Episiotomy and Obstetric Lacerations
- Episiotomy is a surgical incision made during childbirth to widen the vaginal opening and facilitate delivery 4, 5.
- While episiotomy may be associated with an increased risk of obstetrical anal sphincter injury (OASI) and perineal trauma, it is not directly linked to cervical laceration 4, 6.
- The American College of Obstetricians and Gynecologists (ACOG) recommends restrictive use of episiotomy, particularly with unassisted vaginal births, but acknowledges its potential benefits in reducing the risk of OASI in certain situations 6.
Prevention of Perineal Trauma
- Perineal trauma, including obstetrical anal sphincter injury, is a significant concern during vaginal birth, with various risk factors identified, including increased fetal birthweight, operative vaginal birth, and advanced maternal age 6.
- Interventions such as perineal massage, manual perineal protection, and restrictive use of episiotomy may help reduce the risk of perineal trauma, but the evidence is not directly applicable to cervical laceration 6.