Modified median episiotomy minimizes the risk of third-degree tears.

Abstract

The standard median episiotomy can be easily modified by adding two half-inch transverse cuts in opposite directions in the perineal fascia just above the anal sphincter. The use of this new technique, which is referred to as a modified median episiotomy, increases the diameter at the vaginal outlet 83% more than that provided by a median episiotomy alone. The increased diameter is also 10% greater than a mediolateral episiotomy alone. When an episiotomy is indicated, the exclusive use of this procedure makes the occurrence of third-degree tears extremely rare. The episiotomy is easy to repair.