Effect of avoiding routine episiotomy on pelvic organ prolapse: A prospective comparative study

Abstract

Background: Episiotomy has traditionally been performed during vaginal delivery with the belief that it prevents severe perineal trauma and preserves pelvic floor integrity [1, 2]. However, growing evidence discourages its routine use because of its association with increased maternal morbidity. Data evaluating the effect of episiotomy on postpartum pelvic organ prolapse (POP) are limited, particularly in the early puerperal period.Objective: To evaluate the effect of avoiding routine episiotomy on pelvic organ prolapse at six weeks postpartum using the Pelvic Organ Prolapse Quantification (POP-Q) system.Methods: This prospective comparative study was conducted in a tertiary care hospital from October 2023 to August 2025. Sixty primigravidas fulfilling the inclusion criteria were randomly allocated into two groups: Group A (routine episiotomy, N=30) and Group B (no episiotomy, N=30). Labour was monitored using a partogram, and careful perineal support was provided in the no-episiotomy group. Obstetric outcomes including duration of second stage of labour, neonatal birth weight, Apgar scores, and perineal trauma were recorded. POP-Q assessment was performed at six weeks postpartum. Statistical analysis was carried out using Student’s t-test and Chi-square test.Results: The mean age was significantly lower in the no-episiotomy group (P=0.029). No statistically significant difference was observed between the two groups regarding duration of second stage of labour, birth weight, Apgar scores, or severity of perineal trauma. POP-Q staging showed Stage 0 prolapse in 80% of women in the episiotomy group and 73.3% in the no-episiotomy group, while Stage 1 prolapse was noted in 20% and 26.7% respectively (P=0.542). Individual POP-Q point measurements were comparable between groups.Conclusion: Avoiding routine episiotomy did not demonstrate either a protective or causative effect on pelvic organ prolapse at six weeks postpartum. Larger studies with long-term follow-up are required to further evaluate pelvic floor outcomes.