Abstract
<p style="margin-bottom: 0in;"><span style="color: #000000;"><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><span style="color: #231f20;"><em><strong>Objectives: </strong></em></span><span style="color: #231f20;">Estimate the episiotomy rates at two tertiary care units. Find out the practice of analgesia, prior to performing the episiotomy at the two units. Find out the maternal complications within the first 24 hours after episiotomy at the two units. Compare the outcomes at the two units.</span></span></span></span> <span style="color: #000000;"><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><span style="color: #231f20;"><em><strong>Method: </strong></em></span><span style="color: #231f20;">Data collected from medical records of all normal vaginal deliveries (NVD); from 21st April to 20th May 2011 at Anuradhapura Teaching Hospital (ATH) and 20th March to 20th May 2012 at labour room C, Castle Street Hospital for Women (CSHW).<em><strong></strong></em></span></span></span></span> <span style="color: #000000;"><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><span style="color: #231f20;"><em><strong>Results: </strong></em></span><span style="color: #231f20;">The episiotomy rate at ATH was 59%, rate of 85% for primiparous women and a rate of 29.9% for multiparous women. The episiotomy rate at CSHW was 96.5%, a rate of 97.8% for primiparous women and a rate of 94% for multiparous women. All were medio-lateral episiotomies. Except for two women at CSHW who had epidural analgesia in labour, none of the other women had effective analgesia prior to performing episiotomies at both units. All women had 1% - 2% lignocaine infiltrations prior to repair of episiotomy at both the above units. The complications documented within 24 hours due to episiotomy at both units were haematomas, re-suturing, vaginal pack insertions and anaemia.</span></span></span></span> <p style="margin-bottom: 0in;"><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><span style="color: #231f20;"><em><strong>Conclusion: </strong></em></span><span style="color: #231f20;">Episiotomy rate at CSHW was significantly higher than ATH. However at both units the episiotomy rates were higher than the recommended rates and there was no significant difference in the rate of complications at the two units.</span></span></span> DOI: <a href="http://dx.doi.org/10.4038/sljog.v35i1.5997">http://dx.doi.org/10.4038/sljog.v35i1.5997</a> <span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><em>Sri Lanka Journal of Obstetrics and Gynaecology </em></span></span><span style="font-family: Times New Roman,serif;"><span style="font-size: small;">2013; </span></span><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><span style="font-weight: normal;">35</span></span></span><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><span style="font-weight: normal;">:</span></span></span><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"> 10-15</span></span>
Highlights
Episiotomy during vaginal delivery was first recommended in 1920s
Episiotomy rate at Castle Street Hospital for Women (CSHW) was significantly higher than Anuradhapura Teaching Hospital (ATH). At both units the episiotomy rates were higher than the recommended rates and there was no significant difference in the rate of complications at the two units
The rate of episiotomy at CSHW was significantly higher than ATH
Summary
Episiotomy during vaginal delivery was first recommended in 1920s. Episiotomy was initially considered to protect the pelvic floor from lacerations and protect the foetal head from trauma. It was soon adopted as a standard practice and has been widely used since . Since mid1980s, there has been a growing body of evidence that episiotomy does not provide these proposed benefits. World Health Organization’s evidence-based practice for normal birth does not recommend routine episiotomy, and episiotomy is classified as “can be harmful”[2]. Until further research is done, episiotomy should be considered only for certain conditions like; assisted vaginal delivery (forceps or vacuum), preterm delivery, breech delivery, foetal compromise or predicted macrosomia
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