A Cochrane review [Abstract] 1 included 12 studies with a total of 6 177 women. In the routine episiotomy group, 61 to 100% of women had episiotomies, while the rate in the restrictive episiotomy group was 8% to 59%. Compared with routine use, restrictive episiotomy resulted in less severe perineal trauma . There was no clear difference in blood loss at delivery, Apgar score less than seven at five minutes, perineal infection, dyspareunia, or urinary incontinence.
| Outcome | Relative effect(95% CI) | Risk with control -Routine episiotomy | Risk with intervention - Selective episiotomy (95% CI) | №of participants(studies) |
|---|---|---|---|---|
| Severe perineal/vaginal trauma | RR 0.70(0.52 to 0.94) | 3.6 per 100 | 2.5 per 100(1.9 to 3.4) | 5375(8) |
| Blood loss at delivery | - | The mean blood loss at delivery was 278 mL | 27 mL less (95% CI from 75 mL less to 20 mL more) | 336(2) |
| Babies with newborn Apgar score < 7 at 5 minutes | no events | 0 per 100 501(2 | 0 per 100 | 501 (2) |
| Perineal infection | RR 0.90(0.45 to 1.82) | 2 per 100 | 2 per 100(0.9 to 3.6) | 1467(3) |
| Women with moderate or severe pain (measured by visual analogue scale) | RR 0.71(0.48 to 1.05) | 45.1 per 100 | 32 per 100(21.6 to 47.3) | 165(1) |
| Women with long-term dyspareunia (≥ 6 months) | RR 1.14(0.84 to 1.53) | 12.9 per 100 | 14.8 per 100(10.9 to 19.8) | 1107(3) |
| Women with long-term urinary incontinence(≥ 6 months) | RR 0.98(0.67 to 1.44) | 32.2 per 100 | 31 per 100(21.5 to 46.3) | 1107(3) |
Primary/Secondary Keywords