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Published on: June 6, 2020
Risk factors for episiotomy during vaginal birth: A systematic review and meta-analysis
Xuemei He1, Demei Lu1, Ruifeng Ou1
1Department of Obstetrics, The Affiliated FoShan Women and Children Hospital, Guangdong Medical University, FoShan, China.
Medicine
|July 11, 2026
Summary
High newborn weight and oxytocin use significantly increase episiotomy rates during vaginal birth. Other factors like maternal age and labor duration showed no significant association in this meta-analysis.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Evidence-Based Midwifery
Background:
- Episiotomy during vaginal birth, despite known harms, has controversial risk factors.
- Identifying these factors is crucial for informed clinical practice and patient safety.
Purpose of the Study:
- To systematically identify and analyze the risk factors associated with episiotomy during vaginal birth.
- To provide a robust evidence base for clinical decision-making regarding episiotomy.
Main Methods:
- A comprehensive meta-analysis of 16 studies involving 17,502 individuals.
- Systematic literature search across 7 major databases up to January 2025.
- Statistical analysis using Stata 18.0 and Review Manager 5.4, including heterogeneity and bias assessments.
Main Results:
- Significantly elevated risk of episiotomy was associated with higher newborn weight (OR=2.393) and oxytocin use (OR=2.341).
- Maternal age, childbirth attendant type, and second-stage labor duration were not statistically significant risk factors.
Conclusions:
- High newborn weight and oxytocin administration are key predictors of episiotomy.
- Further high-quality research is needed to clarify the role of other potential risk factors due to current evidence limitations.
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