The most common type of episiotomy performed worldwide is:

RML PRE 2025

Obstetrics & Gynaecology

Easy

Appeared in: RML PRE 2025

Explanation

A mediolateral episiotomy is the most frequently performed type across the globe.
The primary advantage and reason for its widespread use is the reduced risk of the incision extending into the anal sphincter complex (a third or fourth-degree tear).
This technique provides a good balance between enlarging the vaginal outlet to facilitate delivery and protecting the integrity of the perineal body and rectum.
Although it may be associated with slightly more blood loss and postoperative pain compared to a median incision, the benefit of avoiding severe perineal trauma makes it the preferred choice in most countries.

Option A: While the median (midline) episiotomy is easier to repair, causes less pain, and results in less blood loss, it is not the most common type worldwide because it carries a significantly higher risk of extending into the anal sphincter and rectum.
Option C: A lateral episiotomy is almost never performed in modern obstetrics. The incision is associated with a high risk of severing the Bartholin's duct, major blood loss, difficult repair, and significant postoperative pain.
Option D: The J-shaped episiotomy is an uncommon modification of the median incision designed to curve away from the sphincter. It is rarely used because it offers no significant advantage over a mediolateral cut and can be more difficult to repair, leading to poor cosmetic results and healing.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Types and prevalence of episiotomy procedures in obstetrics as background academic context rather than a clinical decision trigger.
A nurse's primary role post-episiotomy is careful assessment of the perineum for signs of infection (redness, swelling, discharge), hematoma formation, and wound dehiscence (separation of edges).
Patient education is crucial. The nurse must teach the patient proper perineal care, including the use of sitz baths, perineal irrigation bottles (peri-bottle), and patting the area dry to promote healing and prevent infection.
Pain management is a key nursing intervention, involving the administration of prescribed analgesics and advising the patient on comfort measures like using ice packs in the first 24 hours and then warm sitz baths.

How to Approach the Question

First, identify the core of the question, which asks for the 'most common' type of episiotomy on a 'worldwide' scale. This requires factual recall about obstetric practices.
Recall the different types of episiotomy: median (midline), mediolateral, lateral, and J-shaped.
Analyze the risk-benefit profile for each type. Consider factors like ease of repair, pain, blood loss, and, most importantly, the risk of severe complications.
The key differentiator is the risk of third and fourth-degree tears (obstetric anal sphincter injury or OASIS). The median incision has a high risk, while the mediolateral incision is designed to avoid the sphincter.
Conclude that the technique offering the best protection against severe, long-term complications (anal incontinence) would be the most widely adopted standard, even if it has minor short-term disadvantages. This points to the mediolateral episiotomy.

Concept Tested & Keywords

QsODONB0Ddf6z13B21hoBN

E6 Obstetrics Williams p. 15-31

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 61-75