The Role of Lactic Acid in Episiotomy Wound Healing: A Systematic Review

Episiotomy is a common obstetric intervention aimed at facilitating childbirth and reducing severe perineal trauma. Lactic acid, a naturally occurring alpha-hydroxy acid (AHA), has emerged as a promising alternative to conventional wound-care methods due to its antimicrobial, anti-inflammatory, and regenerative properties. Objective: This systematic review evaluates the effectiveness of lactic acid in episiotomy wound healing compared to conventional wound-care methods, focusing on healing time, infection rates, and patient-reported outcomes. Methods: A systematic search was conducted in PubMed, Cochrane Library, Embase, Web of Science, and Scopus using the keywords "lactic acid", "episiotomy wound healing", "perineal wound care", and "infection prevention". Inclusion criteria covered randomized controlled trials (RCTs), observational studies, and systematic reviews. The Cochrane Risk of Bias 2 (RoB 2) tool and the Newcastle-Ottawa Scale were used for quality assessment. Results: Eight studies met the inclusion criteria. Lactic acid-treated wounds demonstrated 30% faster healing rates, 50% lower infection rates, and reduced pain scores compared with standard wound-care methods (e.g., povidone-iodine or saline). A meta-analysis of five RCTs found a significant reduction in post-episiotomy infections (RR = 0.68, 95% CI: 0.52-0.85). Conclusions: Lactic acid shows promise in episiotomy wound care by improving healing outcomes and reducing infection and discomfort. However, further large-scale RCTs are needed to confirm its safety and long-term efficacy.