Selective episiotomy vs. implementation of a non episiotomy protocol: a randomized clinical trialReportar como inadecuado

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Reproductive Health

, 11:66



BackgroundWorld Health Organization WHO recommends that the episiotomy rate should be around 10%, which is already a reality in many European countries. Currently the use of episiotomy should be restricted and physicians are encouraged to use their clinical judgment to decide when the procedure is necessary. There is no clinical evidence corroborating any indication of episiotomy, so until the present moment it is not yet known whether episiotomy is indeed necessary in any context of obstetric practice.

ObjectivesTo compare maternal and perinatal outcomes in women undergoing a protocol of not performing episiotomy versus selective episiotomy.

Methods-DesignAn open label randomized clinical trial will be conducted including laboring women with term pregnancy, maximum dilation of 8 cm, live fetus in cephalic vertex presentation. Women with bleeding disorders of pregnancy, indication for caesarean section and those without capacity to consent and without legal guardians will be excluded. Primary outcomes will be frequency of episiotomy, delivery duration, frequency of spontaneous lacerations and perineal trauma, frequency of instrumental delivery, postpartum blood loss, need for perineal suturing, number of sutures, Apgar scores at one and five minutes, need for neonatal resuscitation and pH in cord blood. As secondary outcomes frequency complications of perineal suturing, postpartum perineal pain, maternal satisfaction, neonatal morbidity and admission newborn in NICU will be assessed. Women will be invited to participate and those who agree will sign the consent form and will be then assigned to a protocol of not conducting episiotomy experimental group or to a group that episiotomy is performed selectively according to the judgment of the provider of care delivery control Group. The present study was approved by IMIP’s Research Ethics Committee.

Trial RegistrationClinical Trials Register under the number and was registered in under the number NCT02178111.

KeywordsEpisiotomy Vaginal delivery Perineum Randomized controlled trial AbbreviationsIMIPInstituto de Medicina Integral Prof. Fernando Figueira

WHOWorld Health Organization

NICUNeonatal intensive care unit

ACOGAmerican College of Obstetricians and Gynecologists

NNHNumber needed to harm

NNTNumber needed to treat

CONEPNational Committee for Ethics in Research of the Brazilian Ministry of Health

CNPqNational Counsel of Technological and Scientific Development.

Electronic supplementary materialThe online version of this article doi:10.1186-1742-4755-11-66 contains supplementary material, which is available to authorized users.

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Autor: Inês Melo - Leila Katz - Isabela Coutinho - Melania Maria Amorim


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