An episiotomy is planned to facilitate a difficult operative vaginal delivery. Compared with a midline (median) episiotomy, a mediolateral episiotomy is associated with:

• A Higher risk of obstetric anal sphincter injury but better extension control
• B Lower risk of obstetric anal sphincter injury but greater blood loss and poorer healing ✓
• C Equal rates of anal sphincter injury but easier repair
• D Lower postpartum pain and faster return to function

Explanation

Mediolateral episiotomy cuts obliquely away from the midline, sparing the external anal sphincter, so it carries a lower rate of third- and fourth-degree tears than a midline cut, which extends straight toward the anus. The trade-off is greater blood loss, more postpartum pain, and technically harder repair. This is why mediolateral episiotomy is favored for operative vaginal deliveries, particularly in Indian practice where midline cuts are discouraged in nulliparous instrumental births.

Reference: Ian Donald's Practical Obstetric Problems, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.