Episiotomy in modern clinical practice: friend or foe?

  • Maurizio SeratiEmail author
  • Stefano Salvatore
  • Diaa Rizk
Clinical Opinion


The Cochrane library first published a meta-analysis in 2000 on the role of the episiotomy in modern clinical practice, which concluded that only a policy of selective episiotomy is acceptable with evidence-based improvement in maternal health compared with routine episiotomy. Many years later, however, the new version of the Cochrane meta-analysis changed the previous recommendations in that the selective use of episiotomy could not be considered beneficial in all cases. A selective policy is associated with a statistically significant reduction in severe perineal and/or vaginal trauma, whereas routine episiotomy seems to protect against these complications only after instrumental deliveries. Both in the short and the long term, selective medio-lateral episiotomy has no additional beneficial effects without clear evidence of causing harm to the mother or baby.


Anal incontinence Episiotomy Urinary incontinence Pelvic floor dysfunction Vaginal delivery 


Compliance with ethical standards

Conflicts of interest



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Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Urogynecology UnitUniversity of InsubriaVareseItaly
  2. 2.Urogynaecology Unit, Obstetrics and Gynecology Unit, IRCCS San Raffaele HospitalVita-Salute San Raffaele UniversityMilanItaly
  3. 3.Department of Obstetrics and Gynecology, College of Medicine and Medical SciencesArabian Gulf UniversityManamaBahrain

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