Selective episiotomy versus no episiotomy for severe perineal trauma: a systematic review with meta-analysis
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ORIGINAL ARTICLE
Selective episiotomy versus no episiotomy for severe perineal trauma: a systematic review with meta-analysis Gláucia Miranda Varella Pereira 1 & Renato Sugahara Hosoume 2 & Marilene Vale de Castro Monteiro 3 & Cassia Raquel Teatin Juliato 1 & Luiz Gustavo Oliveira Brito 1 Received: 12 September 2019 / Accepted: 7 April 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis We hypothesized whether a non-episiotomy protocol or administration of selective episiotomy as an intrapartum intervention would modify the incidence of obstetric anal sphincter injuries (OASIS). Methods We registered this systematic review with the PROSPERO database (CRD42018111018). Prospective randomized controlled trials (RCTs) were included from databases until February 2019. The primary outcome was OASIS, and the secondary outcomes were any perineal trauma, duration of the second stage of labor, instrumental delivery, and post-partum hemorrhage. The risk of bias (Cochrane Handbook) and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria were used to assess the RCTs. Results A total of 1,833 results (PubMed 650, SCOPUS 1,144, Cochrane Library 33, LILACS 6) were obtained. However, only 2 studies fulfilled the criteria for quantitative analysis and meta-analysis (n = 574). The non-episiotomy arm included two episiotomies (1.7% of deliveries), whereas the selective episiotomy included 33 episiotomies (21.4%). Performance of selective episiotomy demonstrated no difference compared with that of the non-episiotomy group with regard to OASIS (OR = 0.46 [0.15– 1.39]; n = 543; I2 = 0%,p = 0.17), any perineal trauma (OR = 0.90 [0.61–1.33]; I2 = 0%, n = 546, p = 0.59), instrumental delivery (OR = 1.40 [0.80–2.45]; I2 = 0%, n = 545, p = 0.24), duration of the second stage of labor (MD = -3.71 [−21.56, 14.14]; I2 = 72%,n = 546, p = 0.68), perineal pain (MD = 0.59 [0.01–1.17]; I2 = 0%,p = 0.05), and post-partum hemorrhage (OR = 1.75 [0.87–3.54]; I2 = 0%,n = 546,p = 0.12). The evaluated studies displayed a low risk of bias in at least four of the seven categories analyzed. GRADE demonstrated a low certainty for severe perineal tears, postpartum hemorrhage, duration of the second stage of labor, and a moderate certainty for any perineal tear. Conclusions There was no significant difference between non-episiotomy and selective episiotomy regarding OASIS. No RCT was able to confirm a benefit of the non-performance of episiotomies in the non-episiotomy arm. Keywords Episiotomy . Meta-analysis . Perineal trauma . Systematic review
Introduction This study was presented at the Joint Meeting of the American Urogynecological Society and International Urogynecological Association, Nashville, TN, USA, 24–28 September 2019 * Luiz Gustavo Oliveira Brito [email protected] 1
Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária, Campinas 13148-254, Brazil
2
Centro de Referência em Saúde da Mulher
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