E-Posters-Selective Episiotomy versus No Episiotomy for Perineal Trauma: A Systematic Review with Metanalysis

Selective Episiotomy versus No Episiotomy for Perineal Trauma: A Systematic Review with Metanalysis - Luiz Gustavo Oliveira Brito, MD, PhD

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This systematic review with meta-analysis compares the outcomes of selective episiotomy versus no episiotomy for perineal trauma. Episiotomy is a surgical incision made during childbirth to widen the birth canal, but recent research questions its benefits.<br /><br />A total of 1833 results were obtained from various databases, but only two studies remained for quantitative analysis. One study reported a low rate of episiotomies in the non-episiotomy group (1.7% of deliveries), while the other study had a higher rate (21.4% of deliveries). No randomized trial was able to demonstrate the lack of episiotomies in the non-episiotomy group.<br /><br />The main outcomes assessed were severe perineal trauma, any perineal trauma, duration of the second stage of labor, instrumental delivery, and post-partum hemorrhage. The analysis showed that severe perineal trauma presented a non-significant trend to be reduced in the non-episiotomy group. The incidence of postpartum hemorrhage was slightly higher in the non-episiotomy group, but this result was not statistically significant. The duration of the second stage of labor was lower in the non-episiotomy group, although this finding was of very low certainty due to methodological limitations.<br /><br />The review concludes that more studies are needed to determine the impact of not performing episiotomy on maternal and neonatal outcomes. The evidence available so far suggests that selective episiotomy or no episiotomy may not significantly reduce perineal trauma. However, the certainty of this evidence is generally low or very low, highlighting the need for further research on this topic.<br /><br />Overall, this review suggests that the routine use of episiotomy may not be necessary, but more high-quality studies are needed to provide conclusive evidence.

Keywords

systematic review

meta-analysis

selective episiotomy

no episiotomy

perineal trauma

surgical incision

childbirth

quantitative analysis

severe perineal trauma

post-partum hemorrhage