Page 9 AUTHORS' CONCLUSIONS
implications for practice
There is clear evidence to recommend a restrictive use of episiotomy. These results are evident in theoverall comparison and remain after stratification according to the type of cpisiotomy: restrictive mediolateral versus routine mediolateral or restrictive midline versus routine midline. Until further evidence is available, the choice of technique should be that with which the accoucheur is most familiar.
Implications for research
Several questions remain unanswered and further trials are needed to address them. What are the indications for the restrictive use of episiotomy at an assisted delivery(forceps or vacuum), preterm delivery, breech delivery, predicted macrosomia and presumed imminent tears? There is a pressing need to evaluate which episiotomy technique(mediolateral or midline) provides the best outcome.