الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Summary and Conclusions
Episiotomy is one of the most common surgical procedures in the world; it was introduced in clinical practice in the eighteenth century without having a strong scientific evidence for its benefits.
Episiotomy was indicated in the following conditions fetal or maternal distress also when perineum is not distending due to rigidity or delivery of large infant
Timing of episiotomy is very important because if episiotomy is performed early lead to more bleeding .While if episiotomy is performed too late the muscles of the perineal floor will have under gone excessive stretching.
Types of episiotomy are midline episiotomy, mediolateral episiotomy and modified midline episiotomy.
Episiotomy continues to be a frequently used procedure in obstetrics despite little scientific support for its routine use. Episiotomy fails to accomplish the majority of goals stated as reasons for its use. Episiotomy does not decrease damage to the perineum but rather increase it. Episiotomy fails to prevent the development of pelvic relaxation and its attendant complications. Rather than decreasing maternal morbidity also it increases blood loss and is related to greater initial postpartum pain and dyspareunia. It has been associated with a more difficult and lengthy repair as measured by the need for suture material and operating room time, the claims of a protective effect on the fetus in shortening the second stage of labor, improving Apgar scores, and preventing perineal asphyxia have not been to be correct The value of episiotomy use on a routine basis bears. In addition, scientific examination in prospective randomized, controlled trials. These types of trials are certainly achievable, ethically correct, and much needed, until these trials completed and published, obstetricians should not routinely perform the procedure but rather determine the need for episiotomy on a case by case basis.
Episiotomy was initially used based on theoretical benefit with little evidence supporting claims that it prevented sever perineal lacerations or pelvic floor dysfunction, as principles of evidence-based medicine have begun to influence obstetrical practice, the utility of routine episiotomy has been called into question. Several observational studies have suggested that episiotomy increases the risk of third and fourth degree lacerations. A recent Cochrane review of 6 randomized controlled clinical trials comparing routine versus restricted use of episiotomy showed that episiotomy was associated with more second degree perineal trauma, without significant differences in dyspareunia sever perineal trauma or sever pain.
The time has come to take on the professional responsibility of setting and achieving goals for reducing episiotomy use. Much as surgical specialists have reduced use of procedures like knee surgery for arthritis and tonsillectomy in children, clinicians must attend to aligning research evidence and episiotomy use. Clinicians need to work within hospitals, practices, and birthing centers to better track the prevalence of circumstances that likely warrant its use.