American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Sep 2006
Operative vaginal delivery and midline episiotomy: a bad combination for the perineum.
The purpose of this study was to determine the impact of operative vaginal delivery (forceps or vacuum) and midline episiotomy on the risk of severe perineal trauma. ⋯ The use of operative vaginal delivery, particularly in combination with midline episiotomy, was associated with a significant increase in the risk of anal sphincter trauma in both primigravid and multigravid women. Given the reported substantial long-term adverse consequences for anal function, this combination of operative modalities should be avoided if possible.