Routine episiotomy versus selective episiotomy in nulliparous women at term-randomized comparative trial

Dipak Kumar Giri, Deboroop Mandal, Snehamay Chaudhuri


Background: Practice of routine episiotomy is debatable. The study aims to compare maternal and fetal outcome in routine episiotomy versus selective episiotomy in nulliparous women delivering at term.

Methods: Two hundred nulliparous women at term were assigned randomly to receive routine or selective episiotomy during delivery. The primary outcome measures were anterior vaginal trauma, 1st degree perineal tear, 2nd degree perineal tear, 3rd degree perineal tear, 4th degree perineal tear and Apgar score at 1 and 5 minutes. Secondary measures of outcome included consumption of analgesics, anal incontinence, urinary incontinence and dyspareunia.

Results: The episiotomy rate was 90% in routine episiotomy group and 42% in selective episiotomy group. Occurrence of second-degree perineal injury was more common in routine episiotomy group (90% versus 64%; p<0.0001). However, there was no difference in occurrence of 3rd degree perineal tear among the groups. More women in selective episiotomy group suffered from anterior vaginal wall tear (22% versus 54% p<0.0001). There was no difference among the groups in Apgar score, severity of perineal pain, analgesic use on day 2 of delivery, anal incontinence, urinary incontinence, dyspareunia and NICU admission of the neonate.

Conclusions: Routine episiotomy is associated with a higher incidence of perineal injuries without any added benefit for the mother and the baby.


Episiotomy, Perineal tear, Routine episiotomy, Selective episiotomy

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Hewage SA, Abeysena C, Ziard H, Rishard M. Does routine episiotomy for vaginal births prevent major degree perineal tears? Summary of the evidence and its application to Sri Lanka. J Postgrad Inst Med. 2018;5(2):E761-7.

Rodriguez A, Arenas EA, Osorio AL, Mendez O, Zuleta JJ. Selective vs routine midline episiotomy for the prevention of third-or fourth-degree lacerations in nulliparous women. Am J Obstet Gynecol. 2008;198(3):285-e1.

Jiang H, Qian X, Carroli G, Garner P. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Systemat Rev. 2017;2:CD000081.

Belizan J, Campodonica L, Carroli G, Gonzalez L, Lede R, Palermo M, et al. Routine versus selective episiotomy: a randomised controlled trial. Argentine Episiotomy Trial Collaborative Group. Lancet. 1993;342(8886-8887):1517-8.

Hartmann K, Viswanathan M, Palmieri R, Gartlehner G, Thorp J, Lohr KN. Outcomes of routine episiotomy: a systematic review. J Am Medic Assoc. 2005;293(17):2141-8.