Disease relevance of Episiotomy

• Fistula in ano has been reported as a rare complication of midline episiotomy [1].
• The adjusted risk for rectal injury was significantly increased for midline episiotomy (8.9 versus no episiotomy), nulliparity (3.3 versus parous), delivery by a physician (2.4 versus midwife), fetal macrosomia (2.4 versus normal weight), and delivery in a delivery room (2.0 versus labor bed) [2].
• A brief review of meclofenamic acid use for primary dysmenorrhea, menorrhagia, and episiotomy pain is followed by an original study of this compound in postsurgical pain and stress [3].
• Case report: peri-anal episiotomy scar endometrioma imaged by CT and sector endoluminal ultrasound [4].
• The effect of midline episiotomy on the incidence and severity of vaginal outlet lacerations in spontaneous vaginal deliveries was studied in a retrospective manner by pairing women with and without episiotomy on the basis of age, parity and infant birth weight [5].

High impact information on Episiotomy

• METHODS: 1542 women who had a spontaneous vaginal delivery with a second-degree perineal tear or episiotomy were randomly allocated to either the continuous (n=771) or interrupted (771) suturing method, and to either the more rapidly absorbed polyglactin 910 suture material (772) or standard polyglactin 910 material (770) [6].
• Metkephamid and meperidine analgesia after episiotomy [7].
• Nefopam and propoxyphene in episiotomy pain [8].
• In 4 double-blind, randomized, stratified, parallel group studies, single oral doses of fluproquazone (75 to 200 mg), a new nonsteroidal anti-inflammatory analgesic, were compared with aspirin (1,000 mg) and placebo in a total of 672 hospitalized patients with moderate or severe pain following episiotomy or other surgical interventions [9].
• Our results suggest that 45- and 90-mg doses of nefopam induced more analgesia than 65 mg propoxyphene in the relief of episiotomy pain [8].

Chemical compound and disease context of Episiotomy

• These six studies provide strong evidence that ibuprofen is effective for dental pain due to tooth extractions, dysmenorrhea and episiotomy pain [10].

Biological context of Episiotomy

• Based on the results of this conventional postpartum episiotomy pain model, both agents are considered efficacious and ibuprofen 400 mg is a more effective analgesic for the relief of acute pain than acetaminophen 1000 mg [11].
• Topical pramoxine and hydrocortisone foam versus placebo in relief of post partum episiotomy symptoms and wound healing [12].

Anatomical context of Episiotomy

• Midline episiotomy (odds ratio, 2.24; 95% CI, 1.81, 2.77), but not mediolateral (odds ratio, 0.66; 95% CI, 0.375, 1.19), episiotomy was associated with anal sphincter lacerations [13].
• Lidocaine was recently found to rapidly cross the placenta and result in considerable fetal exposure after local infiltration of the perineum for episiotomy [14].
• Complications included autonomic hyperreflexia (9), frequent urinary tract infections, infected pressure sores (3, 2 resulting in below-knee amputations), seizures during and after delivery, pneumonia, bladder stones (2), episiotomy dehiscence (1), and breakdown of spinal fusion [15].

Associations of Episiotomy with chemical compounds

• Lidocaine intoxication in a newborn following local anesthesia for episiotomy [16].
• Meclofenamate sodium is a safe, effective analgesic for acute episiotomy pain [17].
• 4 Compared with placebo, both codeine and hydrocodone (centrally acting narcotics) seemed relatively more effective in uterine cramp than episiotomy pain; the reverse seemed true with acetaminophen (a peripherally acting analgesic) [18].
• Polyglycolic acid (PGA) sutures and traditional catgut were compared in 190 patients undergoing episiotomy [19].
• The use of Histoacryl for episiotomy repair [20].

Gene context of Episiotomy

• Seven clitoridectomies, 25 clitoral recessions, 17 Y-V introitoplasties and 10 midline episiotomies were performed [21].
• Clinical evaluation of zomepirac and APC with codeine in the treatment of postpartum episiotomy pain [22].
• Women who practised perineal massage were less likely to have an episiotomy (three trials, 2417 women, RR 0.85 (95% CI 0.75 to 0.97), NNT 23 (13 to 111)) [23].

Analytical, diagnostic and therapeutic context of Episiotomy

• Indoprofen, 100 mg, was significantly more effective than aspirin, 600 mg, at hour 6 for pain intensity difference (PID) in the episiotomy/cesarean section subset [24].
• Women who underwent forceps-assisted delivery were more likely to be <24 years old, to be nulliparous, and to have had regional anesthesia, midline episiotomies, and infant presentations other than occipitoanterior (P <.001) [25].
• OBJECTIVE: This study was undertaken to estimate the reliability and validity of an objective structured assessment of technical skills (OSATS) for midline episiotomy repair using a lifelike anatomic model [26].
• Thirty post-partum patients, aged 19 to 37 years, were treated for episiotomy pain and inflammation with either 1600 mg ibuprofen (400 mg every 6 hours) or placebo daily for 7 days in a completely randomized, double-blind study [27].
• CONCLUSION: Ketoprofen 25 mg or 50 mg, and dipyrone 500 mg seem to be equally suited for use as pain relief medication after minor surgery, as well as episiotomy [28].

References