Abstract
To determine the prevalence of episiotomy and the factors associated with the knowledge, attitude and practice (KAP) of Brazilian obstetricians in relation to this procedure. A KAP survey was conducted with obstetricians working in Brazil. An electronic form containing structured questions previously evaluated using the Delphi method was created in Google Docs and sent by e-mail. A multivariate logistic regression was performed to determine the principal factors associated with adequate KAP. For each dependent variable (knowledge, attitude and practice) coded as adequate (1 = yes; 0 = no), a multiple logistic regression model was developed. Binary codes (1 = yes and 0 = no) were assigned to every independent or predictor variables. Prevalence ratios (PRs) and their respective 95% confidence intervals (95%CIs) were calculated as measures of relative risk, at a significance level of 5%. Out of the 13 thousand physicians contacted, 1,163 replied, and 50 respondents were excluded. The mean episiotomy rate reported was of 42%. Knowledge was determined as adequate in 44.5% of the cases, attitude, in 10.9%, and practice, in 26.8% of the cases. Most respondents had inadequate knowledge, attitudes and practices regarding episiotomy. Although some factors such as age, teaching, working in the public sector and attending congresses improved knowledge, attitude and practice, we must recognize that episiotomy rates remain well above what would be considered ideal. Adequate knowledge is more prevalent than adequate attitude or practice, indicating that improving knowledge is crucial but insufficient to change the outlook of episiotomies in Brazil.
Highlights
Available scientific evidence corroborates the selective use of episiotomy.[1,2] In its last guideline,[3] the World Health Organization (WHO) recommends against routine/ liberal episiotomy, and acknowledges that there is no evidence to support any indication of episiotomy in modern obstetrics; an “ideal” rate of episiotomy persists to be established
Most respondents had inadequate knowledge, attitudes and practices regarding episiotomy. Some factors such as age, teaching, working in the public sector and attending congresses improved knowledge, attitude and practice, we must recognize that episiotomy rates remain well above what would be considered ideal
Adequate knowledge is more prevalent than adequate attitude or practice, indicating that improving knowledge is crucial but insufficient to change the outlook of episiotomies in Brazil
Summary
Available scientific evidence corroborates the selective use of episiotomy.[1,2] In its last guideline,[3] the World Health Organization (WHO) recommends against routine/ liberal episiotomy, and acknowledges that there is no evidence to support any indication of episiotomy in modern obstetrics; an “ideal” rate of episiotomy persists to be established. The American College of Obstetricians and Gynecologists (ACOG) established in 2006 and corroborated in 2018 that episiotomy should be restricted, and that physicians should use their clinical judgment to decide when the procedure is necessary,[4] since there is no clinical evidence supporting any indication for episiotomy.[1,4] The well-documented risks of routine episiotomy include severe perineal trauma, perineal pain and healing complications.[1]. Despite the worldwide trend toward a reduction in episiotomy rates, the actual performance of this procedure varies considerably from region to region.[5,6] A retrospective study conducted in Israel reported a decline in the rate of episiotomy from more than 30% in the 1990s to less than 5% in 2010.7 In hospital deliveries in Brazil, episiotomy rates vary considerably; the practice remains common. Episiotomy rates around the country declined from $ 94% in 20008 to 76% in 20069 and 54% in 2014.10 this rate is still high, mainly when compared with other countries such as the United States (24.5%),[11] France (13.3%)[12] and the Netherlands (10.8%).[13]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
