Abstract
Rationale, aims, and objectivesThe aim of this study was to focus attention on episiotomy practice in Romanian maternity units in order to identify factors associated with the very high rate of the procedure in Romania and to consider strategies to reduce it.MethodsIn this clustered cross‐sectional study, a total of 11 863 patients were recorded in eight Romanian maternity units to assess the prevalence of episiotomy. A random effects Poisson model was used to estimate the prevalence rate in univariate and multivariate models.ResultsAmong the 11 863 patients included for analysis, 8475 (71.4%) had an episiotomy. The prevalence of episiotomy was 92.7% for the first vaginal birth, 73.2% for the second vaginal birth, and 35% for the third vaginal birth. The overall rate of suturing was higher than the episiotomy rate for all patients (total rate 79.2%). The likelihood of exiting the maternity ward with an intact perineum after the first vaginal birth was less than 5% at the first vaginal birth.ConclusionsIn conclusion, routine episiotomy is the norm in Romanian maternity units, with episiotomy rates among the highest in Europe. Episiotomy use is mainly driven by local professional norms, experiences, previous training, and practitioners' decisions rather than evidence, guidelines, or variations in patient needs at the time of vaginal birth.
Highlights
Episiotomy is a surgical cut of the perineum performed in the second stage of labor in order to facilitate the birth of an infant by enlarging the vaginal opening.[1]
In conclusion, routine episiotomy is the norm in Romanian maternity units, with episiotomy rates among the highest in Europe
We investigated the occurrence of perineal lesions with respect to the practice of episiotomy practice in a univariate analysis for each of the following variables: labial tears, vaginal tears, anterior labial involvement, and cervical tear (Table 2)
Summary
Episiotomy is a surgical cut of the perineum performed in the second stage of labor in order to facilitate the birth of an infant by enlarging the vaginal opening.[1] Episiotomy became a routine practice well before research results were available to support it. The rates of episiotomy in Europe are wide ranging, spanning 3.7% in Denmark to 75.0% in Cyprus.[5] In a multicenter retrospective study conducted between 2003 to 2005 (Period 1) and 2012 to 2014 (Period 2), performed in Burgundy, France, the overall episiotomy rate reduced from 35.8% to 16.7%.6. In North America, a 17% decrease in episiotomy rate from 46.9% to 38.8% was achieved in the year 2006 after the introduction of a physician educational program,[7] whereas another report found that the episiotomy rate ranged from 6.7% to 22.9% in operative vaginal deliveries in 2016.8 In a multicenter retrospective study conducted between 2003 to 2005 (Period 1) and 2012 to 2014 (Period 2), performed in Burgundy, France, the overall episiotomy rate reduced from 35.8% to 16.7%.6 In North America, a 17% decrease in episiotomy rate from 46.9% to 38.8% was achieved in the year 2006 after the introduction of a physician educational program,[7] whereas another report found that the episiotomy rate ranged from 6.7% to 22.9% in operative vaginal deliveries in 2016.8
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