Concerning episiotomy, the following statements are correct:

• A. True
• B. False: Episiotomy is selective, not mandatory in all primiparous women.
• C. False: Midline episiotomy has a higher, not lower, risk of extension into the anal sphincter.
• D. True
• E. False: Episiotomy reduces but does not completely prevent second-degree tears.

Episiotomy facts

Timing and technique

• When indicated, an episiotomy is performed at crowning (premature episiotomy is avoided).
• A mediolateral incision is made at 45-60 degrees from the midline (commonly to the right), starting at the fourchette.

Selective, not routine

Episiotomy is not mandatory in all primiparous women; it is selective (instrumental delivery, fetal compromise, likely severe tear).

Midline vs mediolateral

A midline incision has a higher, not lower, risk of extending into the anal sphincter; mediolateral directs extension away from the sphincter.

Effect on tears

Episiotomy reduces but does not completely prevent severe tears, and second-degree tears can still occur despite episiotomy.

Why A is true

Episiotomy is performed at crowning when indicated.

Why B is false

It is selective, not mandatory in all primiparae.

Why C is false

Midline has a higher, not lower, risk of sphincter extension.

Why D is true

Mediolateral is at 45-60 degrees from the midline.

Why E is false

Episiotomy does not completely prevent second-degree tears.