{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T09:24:56Z","timestamp":1786958696413,"version":"build-2736575974"},"reference-count":29,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T00:00:00Z","timestamp":1786752000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Episiotomy remains one of the most common obstetric procedures worldwide, and suboptimal healing of the perineal wound continues to cause pain, dehiscence, and long-term impairment of postpartum quality of life. Obstetric anal sphincter injury (OASI) carries the greatest risk of severe wound morbidity among perineal trauma types and is managed with prophylactic antibiotics and adjunctive measures; episiotomy, by contrast, is repaired without a comparable prophylactic package and is far more frequent, so that even a modest per-case complication rate carries a substantial absolute burden. Platelet-rich plasma (PRP), an autologous concentrate rich in growth factors, has demonstrated favourable effects on wound healing and scar quality across several surgical contexts, including caesarean section, raising the question of whether it could similarly benefit episiotomy repair. Methods: We conducted a structured, date-stamped search of PubMed, Scopus and Google Scholar, together with two trial registries (ClinicalTrials.gov, WHO ICTRP), forward and backward citation tracking, and reference-list screening of relevant reviews (final search 24 July 2026), to identify clinical studies of PRP for obstetric episiotomy or intrapartum perineal wound healing. Results: Five primary clinical studies and one systematic review were identified. One single-centre randomized controlled trial of 200 primiparous women, published in a regionally indexed journal covered by neither PubMed nor Scopus, evaluated PRP specifically for episiotomy wound healing and reported significantly lower REEDA, Vancouver and pain scores in the PRP arm; it was not prospectively registered, reported neither a sample-size calculation nor blinded outcome assessment, lost 12% of participants to follow-up, and contains internal inconsistencies in the reported data. The remaining evidence comprises one randomized trial of PRP for postpartum levator ani muscle recovery (a distinct target, with a null result), one non-randomized comparative study in grade III\u2013IV intrapartum perineal laceration repair, two case reports, and one broad systematic review of PRP in pelvic floor disorders in which episiotomy was not analyzed as a distinct entity. Conclusions: PRP for episiotomy healing is therefore not wholly untested, but the single existing randomized trial is small, methodologically limited, not independently replicated, and effectively invisible to conventional database searching. We describe this evidence base and introduce PRP-EpiHeal (ClinicalTrials.gov ID: NCT07669285), designed to provide the first prospectively registered, adequately powered and assessor-blinded randomized evidence on this question, with REEDA scale assessment at six weeks postpartum as the primary outcome.<\/jats:p>","DOI":"10.3390\/life16081339","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T08:05:41Z","timestamp":1786953941000},"page":"1339","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7600-0571","authenticated-orcid":false,"given":"Dragos","family":"Brezeanu","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Ovidius University, 900527 Constanta, Romania"},{"name":"County Clinical Emergency Hospital \u201cSt. Apostle Andrew\u201d, 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5631-9509","authenticated-orcid":false,"given":"Ana-Maria","family":"Brezeanu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Ovidius University, 900527 Constanta, Romania"},{"name":"County Clinical Emergency Hospital \u201cSt. Apostle Andrew\u201d, 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7370-9489","authenticated-orcid":false,"given":"Traian-Virgiliu","family":"Surdu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Ovidius University, 900527 Constanta, Romania"},{"name":"Techirghiol Balneal and Rehabilitation Sanatorium, 906100 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5878-1407","authenticated-orcid":false,"given":"Monica","family":"Surdu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Ovidius University, 900527 Constanta, Romania"},{"name":"County Clinical Emergency Hospital \u201cSt. Apostle Andrew\u201d, 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9000-4731","authenticated-orcid":false,"given":"Vlad","family":"Tica","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Ovidius University, 900527 Constanta, Romania"},{"name":"County Clinical Emergency Hospital \u201cSt. Apostle Andrew\u201d, 900591 Constanta, Romania"},{"name":"Romanian Academy of Scientists, 050045 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1080\/14767058.2020.1755647","article-title":"Episiotomy: History, present and future\u2014A review","volume":"35","author":"Ghulmiyyah","year":"2022","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"World Health Organization (1996). Care in Normal Birth: A Practical Guide. Report of a Technical Working Group, World Health Organization. WHO\/FRH\/MSM\/96.24.","DOI":"10.1111\/j.1523-536X.1997.tb00352.x"},{"key":"ref_3","first-page":"CD000081","article-title":"Episiotomy for vaginal birth","volume":"1","author":"Carroli","year":"2009","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_4","first-page":"CD000081","article-title":"Selective versus routine use of episiotomy for vaginal birth","volume":"2","author":"Jiang","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1111\/aogs.12894","article-title":"Variations in rates of severe perineal tears and episiotomies in 20 European countries: A study based on routine national data in Euro-Peristat Project","volume":"95","author":"Blondel","year":"2016","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1111\/1471-0528.18356","article-title":"Complications After Childbirth-Related Perineal Trauma up to Six-Weeks Postpartum: A Prospective Cohort Study","volume":"133","author":"Man","year":"2026","journal-title":"BJOG"},{"key":"ref_7","first-page":"100514","article-title":"Women\u2019s experiences of episiotomy: A literature review","volume":"24","author":"Lundquist","year":"2020","journal-title":"Sex. Reprod. Healthc."},{"key":"ref_8","first-page":"e31620","article-title":"A Review of Episiotomy and Modalities for Relief of Episiotomy Pain","volume":"14","author":"Choudhari","year":"2022","journal-title":"Cureus"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1186\/scrt218","article-title":"Platelet-rich plasma preparation for regenerative medicine: Optimization and quantification of cytokines and growth factors","volume":"4","author":"Amable","year":"2013","journal-title":"Stem Cell Res. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Everts, P., Onishi, K., Jayaram, P., Lana, J.F., and Mautner, K. (2020). Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020. Int. J. Mol. Sci., 21.","DOI":"10.20944\/preprints202010.0069.v1"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1177\/039139888701000111","article-title":"A new technique for hemodilution, preparation of autologous platelet-rich plasma and intraoperative blood salvage in cardiac surgery","volume":"10","author":"Ferrari","year":"1987","journal-title":"Int. J. Artif. Organs"},{"key":"ref_12","first-page":"281","article-title":"Platelet-Rich Plasma in Regenerative Medicine: Possible Applications in Management of Burns and Post-Burn Scars: A Review","volume":"25","author":"Hosseini","year":"2023","journal-title":"Cell J."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Brezeanu, A.-M., Brezeanu, D., and Tica, V.-I. (2025). Intraoperative Platelet-Rich Plasma (PRP) for Post-Cesarean Scar Healing: A Single-Center Randomized Controlled Pilot Study. Healthcare, 13.","DOI":"10.3390\/healthcare13222928"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Brezeanu, A.-M., Brezeanu, D., Stase, S., Chirila, S., and Tica, V.-I. (2025). Intraoperative Platelet-Rich Plasma Application Improves Scar Healing After Cesarean Section: A Prospective Observational Pilot Study. Healthcare, 13.","DOI":"10.3390\/healthcare13222905"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"28","DOI":"10.5005\/jp-journals-10006-2850","article-title":"Efficacy of Prophylactic Autologous Platelet-Rich Plasma in Cesarean Wound Healing","volume":"18","author":"Mitali","year":"2026","journal-title":"J. South Asian Fed. Obstet. Gynaecol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Brezeanu, D., Brezeanu, A.-M., Chirila, S.I., and Tica, V. (2025). A Preliminary Study of Intravaginal Lactic Acid Gel (Canesbalance\u00ae) for Post-Episiotomy Healing: A Randomized Clinical Trial. Healthcare, 13.","DOI":"10.20944\/preprints202506.1508.v1"},{"key":"ref_17","first-page":"93","article-title":"Role of Autologous Platelet-Rich Plasma Solution in Healing of Episiotomy After Normal Vaginal Delivery","volume":"34","author":"Ali","year":"2023","journal-title":"Minia J. Med. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"186","DOI":"10.13181\/mji.oa.226115","article-title":"A Randomized Control Trial of Platelet-Rich Plasma in Supporting the Recovery of Postpartum Levator Ani Muscle Trauma","volume":"31","author":"Moegni","year":"2022","journal-title":"Med. J. Indones."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"511","DOI":"10.24200\/jogcr.11.6.511","article-title":"Platelet-Rich Plasma (PRP) in Third to Fourth Degree Perineal Rupture","volume":"11","author":"Kurniawati","year":"2026","journal-title":"J. Obstet. Gynecol. Cancer Res."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Akhoundova, F., Schumacher, F., L\u00e9ger, M., Berndt, S., Martinez de Tejada, B., and Abdulcadir, J. (2022). Use of Autologous Platelet Rich Plasma (A-PRP) for Postpartum Perineal Repair Failure: A Case Report. J. Pers. Med., 12.","DOI":"10.3390\/jpm12111917"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"728","DOI":"10.31083\/j.ceog.2021.03.2464","article-title":"Effectiveness of Platelet-Rich Plasma Treatment in Perineal Trauma: A Case Report","volume":"48","year":"2021","journal-title":"Clin. Exp. Obstet. Gynecol."},{"key":"ref_22","first-page":"957","article-title":"Role of Platelet-Rich Plasma in Pelvic Floor Disorders: A Systematic Review","volume":"21","author":"Kurniawati","year":"2023","journal-title":"Int. J. Reprod. Biomed."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Berdini, M., Clementi, G., Torcianti, M., Del Bianco, D., Cantori, I., Procaccini, R., and Gigante, A. (2026). Standardization of Platelet-Rich Plasma Preparation in Orthopedics: A Review of the Literature and Proposal for a Reproducible Protocol. LabMed, 3.","DOI":"10.3390\/labmed3010008"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"104593","DOI":"10.1016\/j.amsu.2022.104593","article-title":"Standardization and Validation of a Conventional High Yield Platelet-Rich Plasma Preparation Protocol","volume":"82","author":"Muthu","year":"2022","journal-title":"Ann. Med. Surg."},{"key":"ref_25","first-page":"6","article-title":"REEDA: Evaluating Postpartum Healing","volume":"19","author":"Davidson","year":"1974","journal-title":"J. Nurse Midwifery"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/0091-2182(90)90166-3","article-title":"Psychometric Properties of the REEDA","volume":"35","author":"Hill","year":"1990","journal-title":"J. Nurse Midwifery"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1016\/S0140-6736(74)90884-8","article-title":"Measurement of Pain","volume":"2","author":"Huskisson","year":"1974","journal-title":"Lancet"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"200","DOI":"10.7326\/0003-4819-158-3-201302050-00583","article-title":"SPIRIT 2013 Statement: Defining Standard Protocol Items for Clinical Trials","volume":"158","author":"Chan","year":"2013","journal-title":"Ann. Intern. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1111\/aogs.70089","article-title":"Healing-assessment tools for perineal and cesarean section wounds in postpartum women: A scoping review","volume":"105","author":"Man","year":"2026","journal-title":"Acta Obstet. Gynecol. Scand."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/8\/1339\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T08:32:33Z","timestamp":1786955553000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/8\/1339"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,15]]},"references-count":29,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["life16081339"],"URL":"https:\/\/doi.org\/10.3390\/life16081339","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,15]]}}}