Dear Neil,
Thank you for sharing this important study. The data are particularly striking given the persistently high episiotomy rates among primiparous women in some settings, despite long-standing evidence against routine use. In women with moderate to severe anaemia, this practice clearly increases the risk of postpartum haemorrhage.
The findings underscore the need to prioritise changing intrapartum practice through focused training, supervision, and routine audit, rather than relying on guidelines alone.
Dr Suren Kanayan, MD, PhD
Senior Research Fellow, Department of Obstetricsand Gynaecology:: Yong Loo Lin School of Medicine::
National University of Singapore Clinical Research Center:: MD Block 11, LEVEL4:: 10Kent Ridge Crescent
Singapore119260:: Company Registration No: 200604346E