Third degree perineal tears are a major complication in vaginal childbirth and are more frequent in vaginal operative
deliveries (VOD). Several studies have reported on risk factors associated with severe perineal trauma and its
complications such as fecal and urinary incontinence. Within this, the role performance and type of episiotomy remains
controversial, especially if combined with VOD. Although midline and mediolateral episiotomies are commonly performed
in combination with VOD, their role for prevention of severe perineal trauma in VOD is still unclear. In order to
elucidate the impact of midline and mediolateral episiotomy in conjunction with VOD, the present review focuses on the
potential risks and benefits of these episiotomy types and their role in VOD.
Observational studies suggest that mediolateral episiotomy should be the preferred method to reduce the incidence
of severe perineal trauma if instruments, especially forceps are used for VOD. Midline episiotomies should be
avoided in combination with VOD as they appear to substantially increase the risk for sphincter disruption.