High newborn weight and oxytocin use significantly increase episiotomy risk during vaginal birth
Background
Despite known harms, episiotomy remains a common procedure during vaginal birth, with widely varying rates globally. The decision to perform an episiotomy is often influenced by perceived risk factors, yet many of these factors remain controversial. Identifying clear, evidence-based risk factors is crucial for minimizing unnecessary procedures and improving maternal outcomes, addressing a significant gap in current obstetric practice guidelines.
Study Design
Researchers conducted a systematic review and meta-analysis, searching 7 databases (PubMed/MedLine, Embase, Cochrane, Web of Science, Chinese Knowledge Infrastructure (CNKI), and Wanfang) up to January 2025. The analysis included 16 articles, comprising a total sample size of 17,502 individuals. Statistical analyses, including heterogeneity tests, sensitivity analysis, and publication bias assessment, were performed using Stata 18.0 and Review Manager 5.4 to identify potential risk factors for episiotomy during vaginal birth.
Results
The meta-analysis identified two statistically significant risk factors for episiotomy. Newborn weight was strongly associated with increased risk, showing an odds ratio (OR) of 2.393 (95% confidence interval [CI] 1.627-3.520, P < .001). Similarly, the use of oxytocin during labor was also a significant predictor, with an OR of 2.341 (95% CI 1.652-3.318, P < .001).
Key Findings
- Newborn weight significantly increased episiotomy risk (OR = 2.393, P < .001).
- Oxytocin use during labor significantly increased episiotomy risk (OR = 2.341, P < .001).
- Maternal age was not a statistically significant risk factor (OR = 0.978, P = .466).
- Type of childbirth attendant was not a statistically significant risk factor (OR = 0.920, P = .733).
- Duration of the second stage of labor was not a statistically significant risk factor (OR = 1.299, P = .314).
Why It Matters
This meta-analysis provides clear, actionable insights for obstetric practice, highlighting specific factors that significantly increase the likelihood of episiotomy. Clinicians should consider high newborn weight and oxytocin use as key indicators for increased episiotomy risk, prompting careful assessment and potentially alternative management strategies to reduce unnecessary interventions. This evidence can inform updated clinical guidelines, potentially leading to a reduction in episiotomy rates and improved maternal recovery. While not a peptide intervention, oxytocin's role here is critical for understanding labor management protocols.
episiotomy
vaginal-birth
risk-factors
oxytocin
newborn-weight
meta-analysis