ArticleBMC pregnancy and childbirth2026
Selective episiotomy guided by a perineal evaluation form for forceps-assisted vaginal delivery: a retrospective cohort study on maternal and neonatal outcomes.
Article in BMC pregnancy and childbirth, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundForceps-assisted vaginal delivery is prone to perineal laceration and other complications. Episiotomy decisions are often experience-dependent, leading to excessive intervention. The Perineal Evaluation Form (PEF) provides an objective basis for episiotomy, but its clinical efficacy in forceps-assisted vaginal delivery has not been fully validated.
methodsA single-center retrospective cohort study was conducted on 313 parturients who underwent forceps-assisted vaginal delivery at the Third Affiliated Hospital of Zhengzhou University from January 2017 to December 2024, divided into PEF group (n=194, PEF-guided elective episiotomy) and non-PEF group (n=119, clinician-experience-based episiotomy). Maternal and neonatal outcomes were compared, and multivariate binary logistic regression identified influencing factors of episiotomy.
resultsThe PEF group had a significantly lower episiotomy rate, a shorter second stage of labor, less postpartum 24-hour blood loss, and a lower neonatal transfer rate (all P<0.05). No significant differences were found in severe perineal laceration, other maternal complications or short-term neonatal outcomes (all P>0.05). PEF-guided episiotomy, multiparity and epidural analgesia were protective factors; Class II/III fetal heart rate (FHR) monitoring, oxytocin use and gestational diabetes mellitus (GDM) were risk factors (all P<0.05).
conclusionsPEF-guided elective episiotomy is safe and effective in forceps-assisted delivery, which reduces unnecessary clinical interventions without increasing the risk of severe maternal and neonatal complications. The identified influencing factors provide an evidence-based basis for precise episiotomy decision-making.
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