This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Episiotomy, Subject name: Gynaecology & Obstetrics
In which of these patients can a medial episiotomy be considered superior to a medio lateral episiotomy during delivery of fetus? 
Select and explain. 
A. Nulligravida with thick perineum, B. Second stage arrest, C. Second gravida with moderate anemia, D. Before application of forceps
C: Second gravida with moderate anemia
Answer: C: Second gravida with moderate anemia 
Explanation: A midline episiotomy is associated with higher risk of third and fouh degree lacerations and following factors are associated with an increased risk.: Nulliparity Second-stage arrest of labor Persistent occiput-posterior position, Midorlowforceps Use of local anesthetics Asian race. A medio lateral episiotomy should beperformed in these mentioned situations A multiparous patient with anemia does not have increased risk for third or fouh degree laceration and since the patient is anemic, with a midline episiotomy, blood loss is less and healing is better, making it a better option.