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Objective: To examine the association of the frequency and severity of perineal trauma with episiotomy performed at forceps delivery., Study Design: This retrospective study analyzed all forceps deliveries at the Semmelweis Women's Hospital Vienna between February 1999 and July 1999. Evaluation of a possible association of episiotomy with the frequency and severity of perineal trauma was the main objective of the study. Episiotomy was not performed routinely and was either midline or mediolateral., Results: In conjunction with forceps delivery episiotomy, 76/87 women (87%) underwent forceps delivery episiotomy; among those, 49/76 (64%) had a mediolateral episiotomy and 27/76 (36%) a midline episiotomy. The frequency and severity of perineal tears were significantly lower in forceps deliveries when an episiotomy was performed. When analyzing the type of episiotomy, the data revealed a statistically significantly lower frequency of perineal trauma when mediolateral episiotomy was performed as compared to midline episiotomy., Conclusion: If obstetric indications necessitate forceps delivery, performance of an episiotomy decreases the risk of perineal tears of all degrees. When analyzing the type of episiotomy, mediolateral episiotomy seems to be more protective against perineal trauma in women undergoing forceps delivery.

Objective: To investigate the influence of the traditional hands-on versus the innovative hands-poised method on the risk of perineal trauma during vaginal delivery and on neonatal outcomes., Study Design: In a prospective, randomized, multicenter study, 1,161 of 1,505 women giving birth at the Departments of Obstetrics and Gynecology of the University Hospital of Vienna and Semmelweis Women's Hospital, Vienna, between February and September 1999, were randomized into the trial. In the hands-on method, the left hand of the midwife puts pressure on the infant's head, and the right hand is placed against the perineum. In the hands-poised method, the midwife guides the parturient through the birth without touching the perineum, prepared to apply light pressure on the infant's head., Results: One hundred eighty-seven of 574 women (32.5%) in the hands-on group and 180 of 502 women (35.8%) in the hands-poised group experienced perineal tears (P = .5). Sixteen women (2.7%) treated with the hands-on method developed third-degree perineal tears as compared with five women (0.9%) treated with the hands-poised method (P < .05). In the hands-on group, 103 women (17.9%) underwent episiotomy as compared with 51 cases (10.1%) in the hands-poised group (P < .01). No significant differences in neonatal outcomes were observed between the two groups., Conclusion: Our data suggest that a policy of hands-poised care is more suitable for preserving the perineum during birth and is a safe and effective birthing alternative for women.