Bibliographic information
GuidelineConsolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
Year of Publication2025
Issuing InstitutionWorld Health Organization
Recommendation
New
Routine or liberal use of episiotomy is not recommended for women undergoing spontaneous vaginal birth
Not recommended
Certainty of evidence
Low
Notes and Remarks
- Although the review evidence on comparative effects of episiotomy policies was presented as selective/ restrictive versus routine/liberal use of episiotomy, because of the beneficial effects of selective/restrictive compared with routine/liberal episiotomy policy, the lack of evidence on the effectiveness of episiotomy in general and the need to discourage the excessive use of routine episiotomy across all settings, the GDG felt that it was important to emphasize that routine/liberal use of episiotomy is not recommended, rather than recommending the selective/restrictive use of episiotomy (although this is implied).
- The GDG acknowledged that, at the present time, there is no evidence corroborating the need for any episiotomy in routine care, and an acceptable rate of episiotomy is difficult to determine. The role of episiotomy in obstetric emergencies, such as fetal distress requiring instrumental vaginal birth, remains to be established.
- If an episiotomy is performed, effective local anaesthesia and the woman’s informed consent is essential. The preferred technique is a medio-lateral incision because midline incisions are associated with a higher risk of complex obstetric anal sphincter injury. A continuous suturing technique is preferred to interrupted suturing (39).
- Episiotomies do not warrant the routine use of prophylactic antibiotics, as general infection control measures should be respected at all times