Episiotomy techniques: from history to modern obstetric practice
Spiridonova N.V., Kaganova M.A., Kuzmina A.I.
Episiotomy has been a widely used invasive procedure in obstetrics, reflecting the evolution of attitudes over the centuries. Currently, seven episiotomy techniques have been described, the most common of which are mediolateral, lateral and midline episiotomy. To date, there has been a scientific consensus on the limited use of episiotomy, with mediolateral episiotomy as a priority technique due to its significantly lower risk of complications after childbirth. In addition, a new episiotomy technique without incision of the posterior part of the perineum and distal part of the posterior vaginal wall may be promising in reducing the risk of both immediate and long-term complications.
The restoration of the damaged perineum by using continuous intradermal suturing is a more appropriate technique, as it provides faster and more efficient wound healing, as well as better aesthetic outcomes.
Conclusion: Appropriate episiotomy followed by episiorraphy performed in the correct technique prevents the occurrence of immediate and long-term complications, thereby preserving the quality of life and health of women.
Authors’ contributions: Spiridonova N.V. – developing the concept and design of the review; Kuzmina A.I. – collecting, processing and analysis of the material; Spiridonova N.V., Kaganova M.A., Kuzmina A.I. – writing the text; Spiridonova N.V., Kaganova M.A. – editing the article.
Conflicts of interest: Authors declare lack of the possible conflicts of interests.
Funding: The study was conducted without sponsorship.
For citation: Spiridonova N.V., Kaganova M.A., Kuzmina A.I. Episiotomy techniques:
from history to modern obstetric practice.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (3): 38-44 (in Russian)
https://dx.doi.org/10.18565/aig.2025.202
Keywords
episiotomy
midline episiotomy
mediolateral episiotomy
episiorrhaphy
perineotomy
perineum
childbirth
References
- Токтар Л.Р., Оразов М.Р., Тажетдинов Е.Х., Ли К.И., Пак В.Е., Самсонова И.А., Камарова З.Н. Эпизиотомия в современной практике акушера-гинеколога. Акушерство и гинекология: новости, мнения, обучение. 2022; 10(3): 68-71. [Toktar L.R., Orazov M.R., Tazhetdinov E.Kh., Li K.I., Pak V.E., Samsonova I.A., Kamarova Z.N. Episiotomy in the modern practice of an obstetrician-gynecologist. Obstetrics and Gynecology: News, Opinions, Training. 2022; 10(3): 68-71 (in Russian)]. https://dx.doi.org/10.33029/2303-9698-2022-10-3-68-71
- Чечнева М.А., Реброва Т.В., Климова И.В. Влияние эпизиотомии на состояние тазового дна после вагинальных родов. Российский вестник акушера-гинеколога. 2020; 20(2): 47-54. [Chechneva M.A., Rebrova T.V., Klimova I.V. Effect of episiotomy on the state of the pelvic floor after vaginal delivery. Russian Bulletin of Obstetrician-Gynecologist. 2020; 20(2): 47-54 (in Russian)]. https://dx.doi.org/10.17116/rosakush20202002147
- Clesse C., Lighezzolo-Alnot J., De Lavergne S., Hamlin S., Scheffler M. Socio-historical evolution of the episiotomy practice: a literature review. Women Health. 2019; 59(7): 760-74. https://dx.doi.org/10.1080/03630242.2018.1553814
- Drusany Starič K., Norčič G., Campo G., Distefano R.E.C. Episiotomy and innervation zones of the external anal Sphincter: a case series investigating the impact on neurological patterns. J. Electromyogr. Kinesiol. 2025; 80: 102970. https://dx.doi.org/10.1016/j.jelekin.2024.102970
- Opondo C., Harrison S., Sanders J., Quigley M.A., Alderdice F. The relationship between perineal trauma and postpartum psychological outcomes: a secondary analysis of a population-based survey. BMC Pregnancy Childbirth. 2023; 23(1): 639. https://dx.doi.org/10.1186/s12884-023-05950-6
- Bercovich O., Chen D., Narkis B., Pardo A., Hadar E., Walfisch A. et al. Mediolateral episiotomy and obstetric anal sphincter injuries in nullipara: a propensity score matching study. BMC Pregnancy Childbirth. 2025; 25(1): 76. https://dx.doi.org/10.1186/s12884-025-07184-0
- Токтар Л.Р., Оразов М.Р., Ли К.И., Пак В.Е., Геворгян Д.А., Достиева Ш.М., Тажетдинов Е.Х. Травма промежности в родах и ее последствия. Акушерство и гинекология: новости, мнения, обучение. 2020; 8(3): 94-9. [Toktar L.R., Orazov M.R., Li K.I., Pak V.E., Gevorgyan D.A., Dostieva Sh.M., Tazhedinov E.Kh. Perineal trauma in childbirth and its consequences. Obstetrics and Gynecology: News, Opinions, Training. 2020; 8(3): 94-9 (in Russian)]. https://dx.doi.org/10.24411/2303-9698-2020-13915
- Clesse C., Cottenet J., Lighezzolo-Alnot J., Goueslard K., Scheffler M., Sagot P. et al. Episiotomy practices in France: epidemiology and risk factors in non-operative vaginal deliveries. Sci. Rep. 2020; 10(1): 20208. https://dx.doi.org/10.1038/s41598-020-70881-7
- Houlbracq R., Le Ray C., Blondel B., Lelong N., Chantry A.A., Desplanches T. Episiotomies and obstetric anal sphincter injuries following a restrictive episiotomy policy in France: an analysis of the 2010, 2016, and 2021 National Perinatal Surveys. PLoS Med. 2025; 22(1): e1004501. https://dx.doi.org/10.1371/journal.pmed.1004501
- Desplanches T., Szczepanski E., Cottenet J., Semama D., Quantin C., Sagot P. A novel classification for evaluating episiotomy practices: application to the Burgundy perinatal network. BMC Pregnancy Childbirth. 2019; 19(1): 300. https://dx.doi.org/10.1186/s12884-019-2424-2
- Ye J., Chen Y., Yang H., Chen Q., Huang Y., Zhao J. et al. A nationwide cross-sectional survey of episiotomy practice in China. Lancet Reg. Health West. Pac. 2021; 19: 100345. https://dx.doi.org/10.1016/j.lanwpc.2021.100345
- Hu T., Zhao L., Zhao X., He L., Zhong X., Yin Z. et al. Accurate prediction of mediolateral episiotomy risk during labor: development and verification of an artificial intelligence model. BMC Pregnancy Childbirth. 2025; 25(1): 370. https://dx.doi.org/10.1186/s12884-025-07441-2
- Clesse C., Lighezzolo-Alnot J., De Lavergne S., Hamlin S., Scheffler M. Factors related to episiotomy practice: an evidence-based medicine systematic review. J. Obstet. Gynaecol. 2019; 39(6): 737-47. https://dx.doi.org/10.1080/01443615.2019.1581741
- Зиганшин А.М., Мудров В.А. Дифференцированный подход к проведению эпизиотомии для профилактики акушерского разрыва промежности. Российский вестник акушера-гинеколога. 2020; 20(5): 79-83. [Ziganshin A.M., Mudrov V.A. Differentiated approach to episiotomy for prevention of obstetric perineal rupture. Russian Bulletin of Obstetrician-Gynecologist. 2020; 20(5): 79-83 (in Russian)]. https://dx.doi.org/10.17116/rosakush20202005179
- Alexander S., Blondel B. Of episiotomies, implementation science, and repeating trials. BJOG. 2020; 127(3): 404. https://dx.doi.org/10.1111/1471-0528.16011
- Gachon B., Durocher L., Garabedian C., Guerby P., Chauleur C., Bertholdt C. et al. Episiotomy to prevent obstetric anal sphincter injuries during instrumental delivery in nulliparous women: a national prospective comparative cohort study. Am. J. Obstet. Gynecol. 2025; https://dx.doi.org/10.1016/j.ajog.2025.01.029
- Doumouchtsis S.K., de Tayrac R., Lee J., Daly O., Melendez-Munoz J., Lindo F.M. et al. An International Continence Society (ICS) / International Urogynecological Association (IUGA) joint report on the terminology for the assessment and management of obstetric pelvic floor disorders. Int. Urogynecol. J. 2023; 34(1): 1-42. https://dx.doi.org/10.1007/s00192-022-05397-x
- Choudhari R.G., Tayade S.A., Venurkar S.V., Deshpande V.P. A Review of episiotomy and modalities for relief of episiotomy pain. Cureus. 2022; 14(11): e31620. https://dx.doi.org/10.7759/cureus.31620
- van Bavel J., Hukkelhoven C.W.P.M., de Vries C., Papatsonis D.N.M., de Vogel J., Roovers J.W.R. et al. The effectiveness of mediolateral episiotomy in preventing obstetric anal sphincter injuries during operative vaginal delivery: a ten-year analysis of a national registry. Int. Urogynecol. J. 2018; 29(3): 407-13. https://dx.doi.org/10.1007/s00192-017-3422-4
- DeLancey J.O.L., Masteling M., Pipitone F., LaCross J., Mastrovito S., Ashton-Miller J.A. Pelvic floor injury during vaginal birth is life-altering and preventable: what can we do about it? Am. J. Obstet. Gynecol. 2024; 230(3): 279-94. https://dx.doi.org/10.1016/j.ajog.2023.11.1253
- Ghulmiyyah L., Sinno S., Mirza F., Finianos E., Nassar A.H. Episiotomy: history, present and future - a review. J. Matern. Fetal Neonatal. Med. 2022; 35(7): 1386-91. https://dx.doi.org/10.1080/14767058.2020.1755647
- Freeman M., Rich N., Hickman L., Propst K. Obstetrical anal sphincter injury: counseling for future deliveries. Am. J. Obstet. Gynecol. 2025; 233(5): 345-52. https://dx.doi.org/10.1016/j.ajog.2025.06.037
- Morganelli G., Fieni S., dell'Omo S., Capozzi V.A., Di Serio M., Dall'Asta A. et al. Efficacy of intrapartum bundles and interventions in reducing vaginal delivery-related perineal trauma: a systematic review. Eur. J. Obstet. Gynecol. Reprod. Biol. 2025; 305: 107-16. https://dx.doi.org/10.1016/j.ejogrb.2024.12.008
- Dabiri S.R., Mehri A., Mollanorouzi F., Alavi D., Abdollahi A., Rajabi Mashhadi M.T. Small bowel evisceration after abdominal hysterectomy with open vaginal cuff technique: a case report. Clin Case Rep. 2024; 12(6): e8910. https://dx.doi.org/10.1002/ccr3.8910
- Akpak Y.K., Aktürk E., Oral S., Kıncı M.F., Kanmaz A.G., Bozgeyik M.B. et al. The effect of intrapartum deinfibulation on obstetric outcomes and postpartum sexual function in pregnant women with type 3 female genital mutilation / cutting. Arch. Gynecol. Obstet. 2025; 311(4): 933-40. https://dx.doi.org/10.1007/s00404-024-07923-2
- Ostrzenski A. A novel obstetrical surgical intervention - new episiotomy: case series study. Eur. J. Obstet. Gynecol. Reprod. Biol. 2023; 282: 55-60. https://dx.doi.org/10.1016/j.ejogrb.2022.12.029
- Nassar A.H., Visser G.H.A., Ayres-de-Campos D., Rane A., Gupta S. FIGO Statement: Restrictive use rather than routine use of episiotomy. Int. J. Gynaecol. Obstet. 2019; 146(1): 17-9. https://dx.doi.org/10.1002/ijgo.12843
- Sriram S.N., Dorairajan G., Rane A. Obstetric anal sphincter injury after episiometer-guided versus conventional episiotomy in instrumental deliveries: a randomized controlled trial. Int. Urogynecol. J. 2024; 35(12): 2375-83. https://dx.doi.org/10.1007/s00192-024-05917-x
- Gupta S., Lugt B.V., Vangaveti V., Kulkarni M., Rane A., Amoa A.B. Evaluation of the ease of use and acceptability of an innovative device - the 'Episiometer', in ensuring an accurate mediolateral episiotomy: a pilot study. J. Obstet. Gynaecol. 2019; 39(8): 1065-70. https://dx.doi.org/10.1080/01443615.2019.1584884
- Chouksey R., Veluguleti S.S., Pandey D. Trigonometric characteristics of episiotomy & pregnancy variables. Eur. J. Obstet. Gynecol. Reprod. Biol. X. 2025; 27: 100418. https:/dx./doi.org/10.1016/j.eurox.2025.100418
- Schmidt P.C., Fenner D.E. Repair of episiotomy and obstetrical perineal lacerations (first-fourth). Am. J. Obstet. Gynecol. 2024; 230(3S): S1005-13. https://dx.doi.org/10.1016/j.ajog.2022.07.005
- Маркарьян Д.Р., Гарманова Т.Н., Казаченко Е.А., Лукьянов А.М., Агапов М.А. Техника реконструкции промежности после акушерской травмы. Клиническая и экспериментальная хирургия. Журнал имени академика Б.В. Петровского. 2022; 10 (3): 137-43. [Markaryan D.R., Garmanova T.N., Kazachenko E.A., Lukianov A.M., Agapov M.A. Perineal repair technique after obstetric trauma. Clinical and Experimental Surgery. Petrovsky Journal. 2022; 10(3): 137-43 (in Russian)]. https://dx.doi.org/10.33029/2308-1198-2022-10-3-137-143
- Aydın Besen M., Rathfisch G. The effect of suture techniques used in repair of episiotomy and perineal tear on perineal pain and dyspareunia. Health Care Women Int. 2020; 41(1): 22-37. https://dx.doi.org/10.1080/07399332.2019.1663194
Received 12.09.2025
Accepted 03.03.2026
About the Authors
Natalia V. Spiridonova, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology, Institute of Postgraduate Education, Samara State Medical University, Ministry of Health of Russia, 443100, Russia, Samara, Polevaya str., 80, +7(846)207-19-68, nvspiridonova@mail.ru, https://orcid.org/0000-0003-3390-8034Maria A. Kaganova, PhD, Associate Professor at the Department of Obstetrics and Gynecology, Institute of Postgraduate Education, Samara State Medical University,
Ministry of Health of Russia, 443100, Russia, Samara, Polevaya str., 80, +7(846)207-19-68, mkaganova@yandex.ru, https://orcid.org/0000-0001-5879-418X
Alina I. Kuzmina, 1st year postgraduate student, Department of Obstetrics and Gynecology, Institute of Postgraduate Education, Samara State Medical University, Ministry of Health of Russia, 443100, Russia, Samara, Polevaya str., 80, +7(846)207-19-68, alina.cuzmina555@mail.ru, https://orcid.org/0000-0003-1354-1626
Corresponding author: Natalia V. Spiridonova, nvspiridonova@mail.ru
Similar Articles
