Comparison 1. Restrictive versus routine episiotomy (all).

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2 Number of episiotomies	8	5441	Risk Ratio (M-H, Fixed, 95% CI)	0.38 [0.36, 0.40]
2.1 Midline	2	1143	Risk Ratio (M-H, Fixed, 95% CI)	0.46 [0.41, 0.52]
2.2 Mediolateral	6	4298	Risk Ratio (M-H, Fixed, 95% CI)	0.36 [0.33, 0.38]
4 Assisted delivery rate	6	4210	Risk Ratio (M-H, Fixed, 95% CI)	0.77 [0.56, 1.05]
4.1 Midline	2	1137	Risk Ratio (M-H, Fixed, 95% CI)	0.85 [0.50, 1.46]
4.2 Mediolateral	4	3073	Risk Ratio (M-H, Fixed, 95% CI)	0.72 [0.49, 1.07]
5 Severe vaginal/perineal trauma	5	4838	Risk Ratio (M-H, Fixed, 95% CI)	0.92 [0.72, 1.18]
5.1 Midline	2	1143	Risk Ratio (M-H, Fixed, 95% CI)	0.78 [0.55, 1.10]
5.2 Mediolateral	3	3695	Risk Ratio (M-H, Fixed, 95% CI)	1.10 [0.77, 1.59]
8 Severe perineal trauma	7	4404	Risk Ratio (M-H, Fixed, 95% CI)	0.67 [0.49, 0.91]
8.1 Midline	2	1143	Risk Ratio (M-H, Fixed, 95% CI)	0.74 [0.51, 1.07]
8.2 Mediolateral	5	3261	Risk Ratio (M-H, Fixed, 95% CI)	0.55 [0.31, 0.96]
11 Any posterior perineal trauma	4	2079	Risk Ratio (M-H, Fixed, 95% CI)	0.88 [0.84, 0.92]
11.1 Midline	1	698	Risk Ratio (M-H, Fixed, 95% CI)	0.92 [0.87, 0.99]
11.2 Mediolateral	3	1381	Risk Ratio (M-H, Fixed, 95% CI)	0.85 [0.80, 0.91]
14 Any anterior trauma	6	4896	Risk Ratio (M-H, Fixed, 95% CI)	1.84 [1.61, 2.10]
14.1 Midline	2	1143	Risk Ratio (M-H, Fixed, 95% CI)	2.00 [1.45, 2.77]
14.2 Mediolateral	4	3753	Risk Ratio (M-H, Fixed, 95% CI)	1.80 [1.56, 2.09]
17 Need for suturing perineal trauma	5	4133	Risk Ratio (M-H, Random, 95% CI)	0.71 [0.61, 0.81]
20 Estimated blood loss at delivery	1	165	Mean Difference (IV, Fixed, 95% CI)	−58.0 [−107.57, −8. 43]
21 Moderate/severe perineal pain at 3 days	1	165	Risk Ratio (M-H, Fixed, 95% CI)	0.71 [0.48, 1.05]
22 Any perineal pain at discharge	1	2422	Risk Ratio (M-H, Fixed, 95% CI)	0.72 [0.65, 0.81]
23 Any perineal pain at 10 days	1	885	Risk Ratio (M-H, Fixed, 95% CI)	1.00 [0.78, 1.27]
24 Moderate/severe perineal pain at 10 days	1	885	Risk Ratio (M-H, Fixed, 95% CI)	1.04 [0.67, 1.62]
25 Use of oral analgesia at 10 days	1	885	Risk Ratio (M-H, Fixed, 95% CI)	1.47 [0.63, 3.40]
26 Any perineal pain at 3 months	1	895	Risk Ratio (M-H, Fixed, 95% CI)	0.98 [0.62, 1.55]
27 Moderate/severe perineal pain at 3 months	1	895	Risk Ratio (M-H, Fixed, 95% CI)	1.51 [0.65, 3.49]
28 No attempt at intercourse in 3 months	1	895	Risk Ratio (M-H, Fixed, 95% CI)	0.92 [0.61, 1.39]
29 Any dyspareunia within 3 months	1	895	Risk Ratio (M-H, Fixed, 95% CI)	1.02 [0.90, 1.16]
30 Dyspareunia at 3 months	1	895	Risk Ratio (M-H, Fixed, 95% CI)	1.22 [0.94, 1.59]
31 Ever suffering dyspareunia in 3 years	1	674	Risk Ratio (M-H, Fixed, 95% CI)	1.21 [0.84, 1.75]
32 Perineal haematoma at discharge	1	2296	Risk Ratio (M-H, Fixed, 95% CI)	0.96 [0.65, 1.42]
33 Healing complications at 7 days	1	1119	Risk Ratio (M-H, Fixed, 95% CI)	0.69 [0.56, 0.85]
34 Perineal wound dehiscence at 7 days	1	1118	Risk Ratio (M-H, Fixed, 95% CI)	0.48 [0.30, 0.75]
35 Perineal infection	2	1298	Risk Ratio (M-H, Fixed, 95% CI)	1.02 [0.48, 2.16]
36 Perineal bulging at 3 months -Midline	1	667	Risk Ratio (M-H, Fixed, 95% CI)	0.84 [0.50, 1.40]
37 Urinary incontinence within 3-7 months	2	1569	Risk Ratio (M-H, Fixed, 95% CI)	0.98 [0.79, 1.20]
37.1 Midline	1	674	Risk Ratio (M-H, Fixed, 95% CI)	0.95 [0.68, 1.32]
37.2 Mediolateral	1	895	Risk Ratio (M-H, Fixed, 95% CI)	1.00 [0.76, 1.30]
38 Any urinary incontinence at 3 years	1	674	Risk Ratio (M-H, Fixed, 95% CI)	0.95 [0.77, 1.16]
39 Pad wearing for urinary incontinence	1	674	Risk Ratio (M-H, Fixed, 95% CI)	1.16 [0.71, 1.89]
40 Apgar score less than 7 at 1 minute	4	3908	Risk Ratio (M-H, Fixed, 95% CI)	1.04 [0.76, 1.43]
41 Admission to special care baby unit	3	1898	Risk Ratio (M-H, Fixed, 95% CI)	0.74 [0.46, 1.19]
41.1 Midline	1	698	Risk Ratio (M-H, Fixed, 95% CI)	0.0 [0.0, 0.0]
41.2 Mediolateral	2	1200	Risk Ratio (M-H, Fixed, 95% CI)	0.74 [0.46, 1.19]
42 Anorectal incontinence at 7 months	0	0	Odds Ratio (M-H, Fixed, 95% CI)	0.0 [0.0, 0.0]