EPISIOTOMY AND THE IMPACT ON THE PELVIC FLOOR: BIOMECHANICAL OVERVIEW

Aim: The aim of this review is to provide a comprehensive overview of the available literature on the use of episiotomy and its impact on the pelvic floor and to compare the current knowledge on the subject with recently developed bioengineer programs which allows us to further understand the labor process. Method: We performed a literature research in the PubMed database for studies referring to the use of episiotomy published between 1990 and 2016, without restrictions for language and study type. We then assessed that knowledge to the findings of a new developing bioengineer program which simulates the childbirth, measuring the level of pressure on the pelvic floor and the outcomes. Results: Biomechanical models of childbirth allow the simulation of several incisions on the pelvic floor muscles in order to quantify the effect and consequences of episiotomy. According to the analyzed studies, a mediolateral episiotomy reduces the stress on the muscles and the force required to successfully delivery. These models estimate also that the incision limited muscle injury. There was a strong agreement in the findings of the bioengineering program and the current knowledge about medicine. According to the results of the bioengineering study, a mediolateral episiotomy has a protective effect, reducing the stress on the muscles, and the force required during delivery. The intervention also has benefits on muscle injury, reducing the damage to a small zone. Conclusion: Although there is a strong evidence that the cut applied mediolateral would have less impact on the pelvic floor and a protective effect during delivery, more studies should be made assessing the damage on the perineum and the consequences that may occur (blood loss, infections and others).