L’épisiotomie en France en 2010 : variations des pratiques selon le contexte obstétrical et le lieu d’accouchement

Abstract

To analyze episiotomy rates according to the characteristics of women and maternity units and to study the variability of rates between units and regions. Our study included all vaginal deliveries in the National Perinatal Survey2010 (n=11,322). We estimated the adjusted relative risk of episiotomy (aRR) according to women and maternity units characteristics, and we studied the variance between regions and hospitals using multilevel Poisson regressions, stratified on parity. In 2010, 44.7% of primiparous; 14.2% in multiparous had an episiotomy. The main associated factors were Asian origin (primiparae: aRR=1.32 [1.16-1.51]; multiparae: aRR=2.30 [1.67-3.16]), breech presentation (primiparae: aRR=2.14 [1.87-2.21]; multiparae: aRR=3.32 [2.52-4.38]) and operative vaginal delivery (primiparae: aRR=2.04 [1.89-2.11]; multiparae: aRR=3.19 [2.74-3.72]). Rates varied dramatically between regions (primiparae: 17 to 64%; multiparae: 3 to 21%). The variance was significant between regions and between maternity units after controlling for women and units characteristics. It would be useful to study the attitudes and views of obstetricians and midwives about the protection of the perineum to better understand these differences in practice.