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

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–IV 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.