ReviewReproductive health2025
Network meta-analysis of episiotomy approaches: comparing routine, restrictive, and non-episiotomy strategies and their effects on maternal and neonatal outcomes in primiparous patients.
Review in Reproductive health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
What it found
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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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it.
- 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
- Impact of Episiotomy on Postpartum Pain, Pelvic Floor Function, and Sexual Health: A Propensity Score-Matched Cohort Study and Prediction Model Development.International urogynecology journal · 2026Article
- Selective episiotomy guided by a perineal evaluation form for forceps-assisted vaginal delivery: a retrospective cohort study on maternal and neonatal outcomes.BMC pregnancy and childbirth · 2026Article
- Postpartum Pain and Vaginal-Gut Microbiota Interactions: An Integrative Narrative Review with Implications for Maternal Recovery and Pain Modulation.Journal of pain research · 2026Review
- Postpartum hemorrhage following vaginal delivery and associated risk factors in the United Arab Emirates: The Mutaba'ah study.Women's health (London, England)Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
14 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEpisiotomy, although occasionally required during labor, can result in postpartum discomfort, perineal trauma, and delayed healing. This study offers a comprehensive comparison of the safety and effectiveness of routine, restrictive, and non-episiotomy approaches on maternal and neonatal outcomes.
methodsWe systematically searched PubMed, Web of Science, Scopus, and Cochrane. We included randomized clinical trials (RCTs), comparing routine, restrictive, and non-episiotomy approaches in primiparous pregnant women. We excluded non-randomized trials, conference abstracts, and observational studies. The Cochrane ROB tool 2 was employed to appraise the selected RCTs. We conducted our analysis using the “netmeta” package of RStudio software (v.4.3.0). Dichotomous outcomes were pooled as risk ratios (RR), while continuous outcomes were pooled as the mean differences (MD). We used the random effect model for all outcomes.
resultsSixteen studies, involving 10,738 patients, were included in the network meta-analysis. The findings revealed that the non-episiotomy group had a significantly higher risk of experiencing 1st-degree perineal tear compared to the routine episiotomy group (RR = 4.69, 95% CI [2.04; 10.74], P > 0.01). Similarly, the restrictive episiotomy group showed a significantly higher risk compared to the routine group (RR = 3.88, 95% CI [1.63; 9.26], P > 0.01). However, there were no significant differences observed between the routine, restrictive, and non-episiotomy groups regarding the duration of the 2nd stage of labor, postpartum perineal pain, and the occurrence of 2nd-, 3rd-, and 4th-degree perineal tears.
conclusionIn conclusion, non-episiotomy approaches prove superior, with lower risks of complications compared to routine episiotomy. While restrictive episiotomy performs better than routine, it falls short of non-episiotomy methods. Therefore, non-episiotomy strategies are preferred, followed by restrictive episiotomy, with routine episiotomy being the least favorable. However, individual patient factors should guide treatment decisions, and further research is necessary to refine clinical practices.
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