The Role of Episiotomy in Emergency Delivery

Episiotomy is the surgical enlargement of the vaginal opening, in order to increase the diameter of the soft tissues of the vaginal outlet, facilitate delivery, and ideally prevent perineal tears. Given the risk of complications and the impact of such procedure on postpartum maternal satisfaction and quality of life, the decision to perform episiotomy should be weighted on several factors in order to reduce iatrogenic injuries while maximizing fetal outcomes. For the lack of clear guidelines, the debate on the best technique, timing, and indication of this procedure is still ongoing leading to confusions and disagree among clinicians. The aim of this chapter is to critically review the current practice and the supporting evidence on the role of episiotomy in emergency delivery in order to provide physicians with a strong background on surgical techniques, indications, and surgical complications.