A Comparative Study on Maternal Morbidity after Routine Vs Selective Episiotomy in Primigravida in a Tertiary Care Hospital in Kishanganj, Bihar

Background: The aim is to investigate the risk of short-term maternal morbidity caused by routine vs selective episiotomy in primigravida in a tertiary care hospital in Kishanganj, Bihar. Methodology: This prospective cohort study was undertaken in Department of Obstetrics and Gynaecology, MGM Medical College and LSK Hospital, Kishanganj, Bihar. Most of the referred study with same indication conducted for 3 months of follow up post-delivery per subject. Women fulfilling the criteria were undergone detailed clinical examinations. A detailed history was taken regarding menstrual and obstetrical history with onset of labour pain, duration and associated with rupture of membrane or not. A thorough general physical examination, respiratory system and cardiovascular and CNS examinations was done. In obstetrical examination like uterine height in weeks; lie of the fetus, presentation and position; fetal heart sounds; and estimated fetal weight were noted. Per vaginal examination was done to assess cephalo-pelvic disproportion and the status of cervix by bishop score. Informed consent form was taken. In follow up visits vitals observations like (BP, pulse rate, temp, respiratory rate); episiotomy related complications like skin tag, asymmetry, excessive narrowing of introitus, rectovaginal fistula were noted. Results: In our study in routine episiotomy group, the mean age (mean± s.d.) of patients was 25.38± 4.3887yrs and in selective episiotomy group, the mean Age (mean± s.d.) of patients was 25.08± 3.8377yrs. Difference of mean age with both groups was not statistically significant (p=0.7160). We found that the mean gestational age GA (mean± s.d.) of patients was higher in routine episiotomy group [38.7260± .9847] compared to selective episiotomy group patients [38.6140± .8788] which was not statistically significant (p=0.5499). Conclusion: Routine episiotomy, while once a common practice in obstetrics, may lead to increased rates of anterior vaginal trauma and vaginal tears, particularly first and second-degree tears, compared to the selective episiotomy approach. These findings underscore the potential risks associated with routine episiotomy, including increased maternal discomfort and potential long-term sequelae such as pelvic floor dysfunction. Despite the higher incidence of perineal trauma observed in the routine episiotomy group, no significant differences were observed in other maternal outcomes such as urinary and anorectal incontinence, dyspareunia, or NICU admission rates.