What is it about?
This article critically examines the clinical evidence on platelet-rich plasma (PRP) for wound healing after episiotomy, a surgical incision sometimes performed during vaginal childbirth. We conducted a structured literature search covering PubMed, Scopus, Google Scholar, clinical trial registries, and additional citation sources, with the final search completed on 24 July 2026. Five primary clinical studies and one systematic review were identified. However, only one randomized controlled trial directly investigated PRP for episiotomy wound healing. This trial, published in 2023 in a journal not indexed in PubMed or Scopus, randomized 200 women and reported favourable outcomes for wound healing and pain. Nevertheless, incomplete follow-up, methodological weaknesses, and inconsistencies in the reported data limit confidence in its findings. The remaining studies addressed related but distinct conditions, including pelvic floor muscle recovery, severe perineal lacerations, and individual cases of wound complications. The article therefore identifies two important problems: the limited quality of the available evidence and the difficulty of discovering relevant clinical research published outside major bibliographic databases. It also introduces PRP-EpiHeal, a prospectively registered randomized trial designed to address these limitations. No results from that trial are presented in this article.
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Why is it important?
Complications of episiotomy wound healing can cause postpartum pain, wound dehiscence, infection, and prolonged impairment of quality of life. Although platelet-rich plasma has shown potential in other areas of surgical wound repair, its effectiveness for episiotomy healing remains uncertain. A central contribution of this article is demonstrating how incomplete bibliographic coverage can distort the assessment of existing clinical evidence. A randomized trial directly relevant to episiotomy healing was identified only after extending the search beyond conventional international databases. Recognizing this trial changes the research question. The problem is not the complete absence of randomized evidence, but the absence of sufficiently reliable and independently replicated evidence. The article also explains why results from cesarean wounds, severe perineal lacerations, or pelvic floor muscle injuries cannot automatically be generalized to uncomplicated episiotomy repair. By identifying these limitations, the paper provides a scientific rationale for better-designed clinical trials, including prospectively registered studies with adequate statistical power, standardized PRP protocols, and blinded outcome assessment. Its purpose is to support more reliable clinical research, not to recommend routine PRP treatment before its effectiveness and safety have been adequately established.
Perspectives
As a co-author of this article and a physician in Physical Medicine, Rehabilitation, and Balneology, I consider rigorous evaluation of tissue repair and functional recovery an important aspect of interdisciplinary clinical research. My contributions to this publication included validation, data curation, and visualization, as documented in the article's author contribution statement. One particularly important lesson from this work is that the absence of evidence in major bibliographic databases should not automatically be interpreted as evidence that no relevant clinical studies exist. The identification of a previously overlooked randomized trial illustrates why scientific literature assessment requires attention to regional publications, methodological quality, and the limitations of database coverage. I also consider it essential to distinguish biological plausibility from demonstrated clinical effectiveness. Promising results from related surgical applications do not establish that PRP improves episiotomy wound healing. The PRP-EpiHeal trial was designed to address this question through a prospectively registered randomized study with blinded outcome assessment. Its results will need to be evaluated independently of the rationale presented in this article. I believe this research contributes to a broader principle of evidence-based medicine: clinical innovation should advance through transparent evaluation, reproducible methods, and carefully designed studies rather than through assumptions about treatment efficacy.
Dr Traian Virgiliu Surdu
Universitatea Ovidius din Constanta
Read the Original
This page is a summary of: Platelet-Rich Plasma in Episiotomy Repair: A Critical Appraisal of a Sparse and Partly Non-Indexed Evidence Base and Rationale for a Randomized Controlled Trial, Life, August 2026, MDPI AG,
DOI: 10.3390/life16081339.
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