We carefully read the work by Sagi-Dain et al. , a randomized clinical trial (RCT) asking whether it is time to abandon episiotomy. We congratulate the authors for choosing this theme, we have followed EPITRIAL since the publication of its interim analysis . Routine episiotomy should not be performed, but whether any episiotomy is needed is questioned by the current literature . However, we would like to question some points. First, when the interim analysis was published and the final sample size was estimated in 6,006 pregnant women, the authors stated that a multicenter study would be carried out . In the present study, only one hospital randomized 692 participants. It was not clear why the plan for a multicenter study was abandoned and the study stopped. This may explain why the rate of severe perineal lacerations was not statistically significant. This undermines the final analysis, which concludes that “reduced episiotomy rates were not associated with higher rates of severe perineal tears.” It is curious that within the interventionist paradigm, the statement is formulated in this sense. The systematic review comparing selective episiotomy versus non-episiotomy for severe perineal trauma had a similar conclusion, i.e., that “no RCT was able to confirm the benefit of non-performance of episiotomies in the non-episiotomy arm” .
Is it time to abandon episiotomy use?