Selective episiotomy vs. implementation of a non episiotomy protocol: a randomized clinical trial

Area of Science:

• Obstetrics and Gynecology
• Clinical Trials
• Maternal-Fetal Medicine

Background:

• The World Health Organization (WHO) recommends an episiotomy rate of approximately 10%.
• Current clinical evidence does not strongly support routine episiotomy, prompting a re-evaluation of its necessity.
• Physicians are advised to use clinical judgment for selective episiotomy use.

Purpose of the Study:

• To compare maternal and perinatal outcomes between a protocol of no episiotomy and selective episiotomy.
• To evaluate the impact of episiotomy restriction on delivery complications and newborn health.

Main Methods:

• An open-label randomized clinical trial was conducted.
• Participants included laboring women with term pregnancies, maximum cervical dilation of 8 cm, and a cephalic presentation.
• Exclusion criteria included bleeding disorders, cesarean section indications, and inability to consent.

Main Results:

• Primary outcomes included episiotomy frequency, delivery duration, lacerations, instrumental delivery rates, postpartum blood loss, and Apgar scores.
• Secondary outcomes assessed perineal pain, maternal satisfaction, and neonatal morbidity.
• Women were randomized to either a no-episiotomy protocol or selective episiotomy based on provider judgment.

Conclusions:

• The study aims to provide evidence on the safety and efficacy of avoiding routine episiotomies.
• Findings will inform clinical practice guidelines regarding episiotomy use in obstetric care.