Towards respectful obstetric care
Year: 2024
Type: article
Abstract: Background: Episiotomy became widespread on the assumption that a controlled incision prevents severe spontaneous perineal injury. Evidence from randomized studies has challenged this rationale, although uncertainty remains in operative vaginal delivery. Objective: To critically synthesize evidence available through 31 December 2023 on the transition from routine to selective episiotomy, maternal and neonatal outcomes, operative delivery, and the Argentine context. Methods: A narrative synthesis was prepared from an archived multi-database literature retrieval, focusing on identifiable original trials, systematic reviews, guidelines, and Argentine research and policy. Bibliographic metadata and pivotal findings were cross-checked against journal, evidence-synthesis, or institutional sources. The automated screening output was not treated as a formally adjudicated systematic-review sample. Results: The 1993 Argentine randomized trial reported episiotomy in 30.1% of births under selective policy versus 82.6% under routine policy, with lower rates of several measures of posterior morbidity under selective practice. The 2017 Cochrane review found fewer severe perineal/vaginal injuries when unassisted birth was anticipated (risk ratio 0.70, 95% confidence interval 0.52–0.94; low-certainty evidence), but did not establish superiority for most long-term outcomes. Observational evidence suggests a possible protective association for correctly performed mediolateral/lateral episiotomy during operative delivery, especially in nulliparous women, but its certainty is very low. WHO guidance opposes routine or liberal episiotomy in spontaneous vaginal birth. Argentine research and national policy document a rationale for restrictive practice and informed participation without establishing a reliable, contemporary national episiotomy rate. Conclusions: Evidence through 2023 supports abandoning routine episiotomy in anticipated spontaneous vaginal birth. Selective decisions during operative delivery require individualized risk assessment, technique, clinical expertise, and informed consent. Additional rigorous studies and representative Argentine monitoring are needed.
Source: SAP Nursing Depths Series
DOI: 10.56294/nds2024104
Author: Agustina Campo
Institution: Universidad Abierta Interamericana
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4412089012