A thorough analysis of the literature revealed seven main types of episiotomy : midline, modified

median, J-shaped, mediolateral, lateral, radical lateral, and anterior.

Midline (median, medial), episiotomy begins at the fourchette and extends to a half of the length of the
perineal body.

Modified median episiotomy differs from the previous type by two transverse cuts in opposite
directions slightly anteriorly of the expected margins of the external anal sphincter (EAS). Transversely,
only subcutaneous tissues, not the skin, may be incised.

J-shaped episiotomy runs initially as a midline incision and then at approximately 2,5 cm from the anus
is curved to avoid the anal sphincter. The latter part of episiotomy is directed towards in the ischial
tuberosity.

Mediolateral episiotomy is a compromise between midline and lateral episiotomy. The result of recent
research clearly demonstrate that the definition of mediolateral episiotomy has thus far been
unsastisfactory. A wide varienty in the clinical performance of mediolateral episiotomy has been
observed between countries and institusion as well as between individual doctors and midwives. based
on studies evaluating the placement of episiotomy, an angle of episiotomy of 60O has been proposed as
part of the definition. Therefore, mediolateral episiotomy is defined as an incision starting at the
posterior fourchette in the midline and directed at an angle of least 60o towards the ischial tuberosity.

Lateral episiotomy, begins in the vaginal introitus 1 -2 cm laterally from the midline and is directed
towards the ischial tuberosity. Lateral episiotomy is often non-mentioned in obstetric literature, this
type has been reported in only one RCT. The Cochrane review sugest that “there is a pressing need to
evaluate which episiotomy technique (mediolateral or midline) provides the best outcome” thus not
taking lateral episiotomy into account. Also, a review analyzing seven commonly sold general textbooks
evaluates whether “both methotds of performing episiotomy (median/mediolateral)” are discussed in
the texts, so again no other type of episiotomy is mentioned. However, it has been found that lateral
episiotomy has in fact been used, albeit unintentionally by wider medical community, in Europe. In both
Finland and Greece this type of episiotomy is used routinely.

Radical lateral (Schuchardt incision), is an original non-obstetrical episiotomy performed at the

beginning of radical vaginal hysterectomy or tracelectomy, starting as lateral episiotomy but passing
around the rectum is a downward, lateral curve. Only rarely it is recommended as an aid to childbirth
during complicated deliveries.

Anterior episiotomy (deinfibulation – opening the scar associated with female genital mutilation). A
potential choice for labour an also antenatally, the anterior scar tissue is incised in the midline up to the
urethra. Due to the possibility of tissue stretching at the end delivery, it may be deemed necessary to
employ an alternative type of episiotomy.
Types of Episiotomy

An episiotomy should always be noted in the delivery record, as well as any extensions that occur. You
must also be specific about the type of episiotomy. The most common types of episiotomies are a
midline episiotomy and a mediolateral episiotomy although a modified mediolateral episiotomy is also
sometimes used.

Midline, a midline episiotomy is almost always used, whereas a mediolateral episiotomy is commonly
employed in other parts of the world. When an MLE is cut, the fingers of the non-dominant hand are
placed between the baby and the perineum and scissors are the used to make a midline incision in the
perineum into the perineal body. Care is taken not to incise the anal sphinctyer or cut the fetus at the
time the incision is made.

Mediolateral, is made the same way as a MLE in terms of how the hands are positioned, but the scissors
are angled at approximately 60 degrees towards the ischial tuberosity in a attempt to direct any
extension that may occur with delivery around the anal sphincter.

Modified Mediolateral, a modification of the MLE that is sometimes used is called a modified
mediolateral episiotomy. In doing this, the incision is initially directly inferior, just like an MLE, for
approximately 2 cm, and then directed laterally at 45 degree angle. This is meant to prevent the incision
from severing the junction of the bulbocavernosus and transverse perineal muscles while still directing
the incision, and hopefully any extension, lateral to the anal sphincter.