GENERAL GYNECOLOGY Does mediolateral episiotomy decrease central defects of the anterior vaginal wall? Cetin Cam • Mehmet Resit Asoglu • Selcuk Selcuk • Turan Aran • Niyazi Tug • Ates Karateke Received: 11 March 2011 / Accepted: 20 June 2011 Ó Springer-Verlag 2011 Abstract Objective This retrospective study investigates the effects of mediolateral episiotomy on the pelvic floor. Methods Premenopausal women suffering from urinary incontinence/genital prolapse who delivered only by vaginal route were enrolled into the study. History of diabetes, morbid obesity (BMI [ 40 kg/m 2 ), vacuum/for- ceps extraction, perineal lacerations that warranted repair during labor and any pelvic surgery were the exclusion criteria. Evaluation of the patients included pelvic organ prolapse quantification scores, presence of stress inconti- nence, urethral hypermobility, and questionnaires were obtained for overactive bladder and anal incontinence symptoms. These data obtained from patients with the history of mediolateral episiotomy were compared with those of patients with no episiotomy or any other pelvic injury that warranted surgical repair. Results Groups were identical by means of demographic data, POP-Q findings, signs and symptoms of the pelvic floor. However, in the MLE group, central defects on the anterior vaginal wall were less frequent. Conclusion According to the results of this retrospective study, MLE seems to prevent central defects on the anterior vaginal wall. Prospective randomized studies are needed to draw a sufficient conclusion. Keywords Episiotomy Á Mediolateral episiotomy Á Pelvic prolapse Á Central defect Introduction Episiotomy was first suggested by Ould more than 250 years ago [1] to prevent perineal/rectal trauma, and pelvic relaxation [2]. Although commonly used, maternal risks and benefits of episiotomy are still controversial and its practice varies widely. A recent Cochrane data- base systemic review showed that restrictive episiotomy policies appear to have a number of benefits compared to routine policies but it increases the risk of anterior per- ineal trauma [3]. Most research in the medical litera- ture is focused on posterior perineal trauma, protection of the perineal body and anal sphincter incontinence. Interestingly, anterior perineal trauma during parturi- tion is considered to be with ‘minimal morbidity’ [4]. Second stage of labor is not without harm for the anterior support of the vagina [5–7] and stretching of tissues of the anterior vaginal wall may result in anterior support defects, which are also called distention cysto- celes [8]. Most of the data about routine episiotomy originate from clinical trials dealing with immediate maternal results and outcomes have not been followed up into the age range, in which women are most likely to have sequelae [9]. Inevi- tably, evidence regarding long-term sequelae of episiotomy is fair to poor. In this retrospective study, we aimed to evaluate the long-term effects of mediolateral episiotomy (MLE) on anterior pelvic floor comparing data of women with epi- siotomy and women without episiotomy. C. Cam Á M. R. Asoglu Á S. Selcuk (&) Á T. Aran Á N. Tug Á A. Karateke Department of Obstetrics and Gynecology, Zeynep Kamil Hospital, Burhanettin Ustunel C., No:20, Uskudar, 34668 Istanbul, Turkey e-mail: md_sel@hotmail.com 123 Arch Gynecol Obstet DOI 10.1007/s00404-011-1965-z