Does routine episiotomy for vaginal births prevent major degree perineal tears? Summary of the evidence and its application to Sri Lanka

Abstract

An updated Cochrane Review concluded that in addition to increasing the risk of major perineal/vaginal trauma by 30%, routine episiotomy does not play a role in lowering the risk of many other outcomes including blood loss at delivery, perineal pain, delivering a non-asphyxiated baby or urinary incontinence at six months compared to selective episiotomy. This review evaluated 12 randomized controlled trials carried out on 6177 women from Europe, North America, South America, South Asia and South-East Asia. Following critical evaluation of the systematic reviews conducted so far in this field along with local evidence and the aptness of this evidence to local setting, we strongly recommend changing the current practice of routine episiotomy to selective episiotomy in vaginal delivery, in accordance with the National Guidelines of Sri Lanka.