SynthesisThe Cochrane database of systematic reviews2009
Episiotomy for vaginal birth.
Synthesis in The Cochrane database of systematic reviews, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 147 papers, 10 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Postpartum Dyspareunia Resulting From Vaginal Atrophy: Prevalence, Characteristics and Risk Factors
The Effect of Episiotomy on Advanced Perineal Tears and Other Maternal and Fetal Outcomes - Randomized Controlled Multicentric Trial (EPITRIAL)
Prevalence of Obstetric Anal Sphincter Injury With a Reducing Episiotomy Rate
Physiotherapeutic Protocol Compared to Usual Care in the Treatment of Postpartum Primiparas After Perineal Trauma: A Type 1 Hybrid Effectiveness-Implementation Randomized Controlled Trial With Economic Evaluation
Who cites it
147 citing papers in PubMed, 10 syntheses or guidelines pooled it, 700 citations in OpenAlex.
- Comparative effectiveness of physical interventions for preventing perineal trauma during vaginal delivery: a systematic review and Bayesian network meta-analysis.Frontiers in medicine · 2026Pooled it
- Primary Carcinomas of the Episiotomy Scar Site: A Systematic Literature Review.Current oncology (Toronto, Ont.) · 2025Pooled it
- The Risk Factors of Postpartum Urinary Retention for Women by Vaginal Birth: A Systematic Review and Meta-Analysis.International urogynecology journal · 2024Pooled it
- Birth-Related Perineal Trauma in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis.Maternal and child health journal · 2019Pooled it
- Antibiotic prophylaxis for episiotomy repair following vaginal birth.The Cochrane database of systematic reviews · 2017Pooled it
- Selective versus routine use of episiotomy for vaginal birth.The Cochrane database of systematic reviews · 2017Pooled it
- Obstetric anal sphincter injuries after episiotomy: systematic review and meta-analysis.International urogynecology journal · 2016Pooled it
- Antepartum use of Epi-No birth trainer for preventing perineal trauma: systematic review.International urogynecology journal · 2015Pooled it
- Hyaluronidase for reducing perineal trauma.The Cochrane database of systematic reviews · 2014Pooled it
- Guidelines for the management of third and fourth degree perineal tears after vaginal birth from the Austrian Urogynecology Working Group.International urogynecology journal · 2013Guideline
- In women with spontaneous vaginal delivery, repair of perineal tears might be easier compared to episiotomy.International urogynecology journal · 2021Trial
- Is it time to abandon episiotomy use? A randomized controlled trial (EPITRIAL).International urogynecology journal · 2020Trial
- No episiotomy versus selective lateral/mediolateral episiotomy (EPITRIAL): an interim analysis.International urogynecology journal · 2018Trial
- Selective episiotomy vs. implementation of a non-episiotomy protocol: a randomized clinical trial.Reproductive health · 2017Trial
- Trial
- Selective episiotomy vs. implementation of a non episiotomy protocol: a randomized clinical trial.Reproductive health · 2014Trial
- Alternative model of birth to reduce the risk of assisted vaginal delivery and perineal trauma.International urogynecology journal · 2012Trial
- Low and high-frequency TENS in post-episiotomy pain relief: a randomized, double-blind clinical trial.Brazilian journal of physical therapyTrial
- Transfer of Restrictive Episiotomy Practice with Low OASIS Rate from Tertiary to Primary Care Level-Lessons Learned and Future Challenges.Healthcare (Basel, Switzerland) · 2026Article
- Platelet-Rich Plasma in Episiotomy Repair: A Critical Appraisal of a Sparse and Partly Non-Indexed Evidence Base and Rationale for a Randomized Controlled Trial.Life (Basel, Switzerland) · 2026Article
87 more citing papers are in PubMed but not listed here.
Corrections and comments
- Updated by
Authors and funding
2 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEpisiotomy is done to prevent severe perineal tears, but its routine use has been questioned. The relative effects of midline compared with midlateral episiotomy are unclear.
objectivesThe objective of this review was to assess the effects of restrictive use of episiotomy compared with routine episiotomy during vaginal birth. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2008). SELECTION CRITERIA: Randomized trials comparing restrictive use of episiotomy with routine use of episiotomy; restrictive use of mediolateral episiotomy versus routine mediolateral episiotomy; restrictive use of midline episiotomy versus routine midline episiotomy; and use of midline episiotomy versus mediolateral episiotomy. DATA COLLECTION AND ANALYSIS: The two review authors independently assessed trial quality and extracted the data. MAIN
resultsWe included eight studies (5541 women). In the routine episiotomy group, 75.15% (2035/2708) of women had episiotomies, while the rate in the restrictive episiotomy group was 28.40% (776/2733). Compared with routine use, restrictive episiotomy resulted in less severe perineal trauma (relative risk (RR) 0.67, 95% confidence interval (CI) 0.49 to 0.91), less suturing (RR 0.71, 95% CI 0.61 to 0.81) and fewer healing complications (RR 0.69, 95% CI 0.56 to 0.85). Restrictive episiotomy was associated with more anterior perineal trauma (RR 1.84, 95% CI 1.61 to 2.10). There was no difference in severe vaginal/perineal trauma (RR 0.92, 95% CI 0.72 to 1.18); dyspareunia (RR 1.02, 95% CI 0.90 to 1.16); urinary incontinence (RR 0.98, 95% CI 0.79 to 1.20) or several pain measures. Results for restrictive versus routine mediolateral versus midline episiotomy were similar to the overall comparison. AUTHORS'
conclusionsRestrictive episiotomy policies appear to have a number of benefits compared to policies based on routine episiotomy. There is less posterior perineal trauma, less suturing and fewer complications, no difference for most pain measures and severe vaginal or perineal trauma, but there was an increased risk of anterior perineal trauma with restrictive episiotomy.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.