Episiotomy Rate Research Articles

Introduction de la manœuvre de Couder et évolution des lésions périnéales

ObjectiveTo analyse the introduction of the Couder manoeuvre in our level 3 maternity unit shortly after its introduction in 2019. Then, to evaluate and compare the rate of perineal injuries between 2017, when the manoeuvre was not performed at all, and 2020. Materials and methodA single-centre retrospective study of patients who delivered a singleton eutociously at term from 1 January to 31 December 2017 and 2020. ResultsIn total, 2930 records were analysed. The Couder manoeuvre rate was 32.12% in 2020. A change in the distribution of perineal lesions was observed: the rate of intact perineum increased (P<0.001), while 2nd degree lesions decreased between 2017 and 2020 (P<0.05). The 1st degree perineum and obstetric anal sphincter injuries remained stable. The rate of episiotomy decreased significantly by almost a factor of 7. ConclusionThe practice of the Couder manoeuvre can be implemented fairly quickly after training of the actors with nearly a third of normal deliveries at term concerned one year after its introduction. This manoeuvre seems, in our practice, to have contributed to the reduction, as previously reported, of the rate of second degree perineal injuries.

Midwives’ Perceptions, Experience and Reasonsfor Routine Episiotomy in Maternity Teaching Hospitals - Khartoum State- Sudan

Background: Midwives have a crucial role in caring for women with normal labor. Routine episiotomyhas no benefit and its used is not scientifically supported. Understanding midwives’ perception andexperiences would target the situation.This study aimed to explore midwives’ perceptions,experienceand reasons for routine episiotomy.Methods: A cross-sectional exploratory study was conductedin three maternity teaching hospitalsin Khartoum state on 85 midwives recruited randomly and consented to take part in the study. Aquestionnaire was constructed for the purpose of the study, and data were collected by interview withmidwives, on reasons for and rate of episiotomy and perceptions of midwives were recorded on a Likertscale. Suitable statistical methods were used.Results: A high percentage of the study participants 64(75.4%) were nurse midwives had a midwiferycertificate. With long years of experience more than ten years 54 (63.5%).The rate of episiotomieswas high 73(85.9%).The midwives reported nine clinical reasons , mainly preventscomplications,Prevents the perineum tears and helping birth (93%, 90%, 84.7%) respectively.Midwives perceivedthat; episiotomy “speeds up the second stage of labor”, “prevent perineal tears and urinary and fecalincontinence”, “Reduces fetal and maternal distress”,shoulder dystociacomplications, bleeding,laborpain, instrument-assisted delivery and allow for easier suturing”.There was a significant correlationbetween Midwives practice and their education with, P value =.001.Conclusion:The rate of routine episiotomy was high with Midwives misleading perspectives andviews

Trend and Inequality in Episiotomy in Southern Brazil, 2007-2016: Evidence of Reduced Abusive Practice.

This study aimed to measure the prevalence, to describe the trend over time, and to evaluate socioeconomic inequalities in the occurrence of episiotomies in 2007, 2010, 2013, and 2016 in the municipality of Rio Grande, in Southern Brazil. We included all women who had vaginal delivery in each of the studied years. All the information was obtained through a questionnaire applied at maternity wards within 48h after delivery. The outcome consisted of episiotomy. A chi-square test was used to evaluate the linear trend. Absolute and relative inequalities were assessed from household income and schooling of the women through the Slope Index of Inequality and Relative Index of Inequality, respectively. This study included 4,521 parturients. The episiotomy rate in the period fell from 71.0% (95%CI: 68.4-73.5) in 2007 to 40.1% (95%CI: 37.3-42.8) in 2016, and it was more frequent among women with higher income and higher schooling. We observed a reduction in the rate of episiotomy in all income and schooling levels, and this was more evident among women in the lowest socioeconomic levels. Absolute inequality declined, while relative inequality remained unchanged. Despite the significant reduction in the rate of episiotomy, its occurrence remains high. Women with higher income and education, therefore with lower risk for complications during childbirth, were the most frequently submitted to this procedure. Routine use of episiotomy must be reevaluated, especially among pregnant women with better socioeconomic status.

A Quasi-Experimental Study to Compare the Effect of Respectful Maternity Care Using Intrapartum Birth Companion of Her Choice on Maternal and Newborn Outcome in Tertiary Care Centre.

Traditionally during labour woman is supported by another woman. However, in hospitals, continuous support during labour has often become the exception rather than the routine. Worldwide, there is a growing concern about the disrespect and abuse of women seeking maternity care. This prompted us to decide to change the obstetric care practices by providing a birth companion of her choice to women during labour and compare their maternal and newborn outcomes with the data from the same institute before intervention. This was a quasi-experimental study conducted in the Department of OBGY, GMCH, Aurangabad for 20months and compared with the previous data from the same institute before implementation of the birth companion policy. The impact of this intervention was evaluated by caesarean section rate, episiotomy rates and admission to neonatal intensive care units, and data was analysed by an appropriate statistical test. The rate of caesarean Section (20%) and episiotomy (8.57%) was significantly lower in the intervention group than in the control group. The rate of NICU admission and time required for initiation of breastfeeding was significantly lower in the intervention than in the control group. Around 86.6% of women from the intervention group were fully satisfied with the role of birth companion and 13.4% were partially satisfied. Our study demonstrated that the use of an intrapartum birth companion of her choice helped us improve maternal and newborn outcomes without any harm. We recommend generalizing the policy of use of the trained birth companion of her choice in the private as well as the public sector.

Influence of a Virtual Exercise Program throughout Pregnancy during the COVID-19 Pandemic on Perineal Tears and Episiotomy Rates: A Randomized Clinical Trial.

The complications associated with COVID-19 confinement (impossibility of grouping, reduced mobility, distance between people, etc.) influence the lifestyle of pregnant women with important associated complications regarding pregnancy outcomes. Therefore, perineal traumas are the most common obstetric complications during childbirth. The aim of the present study was to examine the influence of a supervised virtual exercise program throughout pregnancy on perineal injury and episiotomy rates during childbirth. A randomized clinical trial design (NCT04563065) was used. Data were collected from 98 pregnant women without obstetric contraindications who attended their prenatal medical consultations. Women were randomly assigned to the intervention (IG, N = 48) or the control group (CG, N = 50). A virtual and supervised exercise program was conducted from 8–10 to 38–39 weeks of pregnancy. Significant differences were found between the study groups in the percentage of episiotomies, showing a lower episiotomy rate in the IG (N = 9/12%) compared to the CG (N = 18/38%) (χ2 (3) = 4.665; p = 0.031) and tears (IG, N = 25/52% vs. CG, N = 36/73%) (χ2 (3) = 4.559; p = 0.033). A virtual program of supervised exercise throughout pregnancy during the current COVID-19 pandemic may help reduce rates of episiotomy and perineal tears during delivery in healthy pregnant women.

Comparison of vaginal birth outcomes in midwifery-led versus physician-led setting: A propensity score-matched analysis.

BackgroundExperts in many countries are recommending a scaling up midwifery-led care as a model to improve maternal and newborn outcomes, reduce rates of unnecessary interventions, realise cost savings, and facilitate normal spontaneous vaginal birth.ObjectiveThe aim of this study was to compare midwifery-led and obstetrician-gynaecologist-led care-related vaginal birth outcomes.ParticipantsPregnant women in Kaunas city maternity care facilities.MethodsA propensity score-matched case–control study of midwifery-led versus physician-led low-risk birth outcomes. Patient characteristics and outcomes were compared between the groups. Continuous variables are presented as mean ± standard deviation and analysed using the Mann–Whitney U test. Categorical and binary variables are presented as frequency (percentage), and differences were analysed using the chi-square test. Analyses were conducted separately for the unmatched (before propensity score matched [PSM]) and matched (after PSM) groups.ResultsAfter adjusting groups for propensity score, postpartum haemorrhage differences between physician-led and midwifery-led labours were significantly different (169.5 and 152.6 mL; p = 0.026), same for hospital stay duration (3.3 and 3.1 days, p = 0.042). Also, in matched population, significant differences were seen for episiotomy rates (chi2 = 4.8; p = 0.029), newborn Apgar 5 min score (9.58 and 9.76; p = 0.002), and pain relief (chi2 = 14.9; p = 0.002). Significant differences were seen in unmatched but not confirmed in matched population for obstetrical procedures used during labour, breastfeeding, birth induction, newborn Apgar 1 min scores, and successful vaginal birth as an overall spontaneous vaginal birth success measure.ConclusionThe midwifery-led care model showed significant differences from the physician-led care model in episiotomy rates, hospital stay duration and postpartum haemorrhage, and newborn Apgar 5 min scores. Midwifery-led care is as safe as physician-led care and does not influence the rate of successful spontaneous vaginal births.

Perspectives of skilled birth attendants and pregnant women regarding episiotomy: a quantitative approach.

The World Health Organization recommended less than 10% episiotomy rate for Skilled Birth Attendants (SBAs) and hospitals in 1996. More than two decades afterwards, some health facilities are still grappling with meeting the set target. This study assessed the perspectives of SBAs and pregnant women regarding episiotomy in a Nigerian university teaching hospital. A cross-sectional design was employed. Census sampling was used to select 19 SBAS and 973 vaginal birth records from 2019, while consecutive sampling technique was used to enrol 134 consenting pregnant women obtaining antenatal services in the facility. Data was collected using a three part instrument involving a data extraction sheet, episiotomy practice questionnaire for SBAs, and feelings about episiotomy questionnaire for pregnant women. Assembled data were summarised with descriptive statistics. The episiotomy rate was 345(35.5%). About 266 (77.1%) of first time mothers (primips) and 79(22.9%) of nonfirst time mothers (multips) received episiotomy. Ten (52.6%) of the SBAs were unsure of any evidence supporting routine episiotomy. All the 19(100%) SBAs reported that there was no existing facility-based policy regarding routine episiotomy. Seventy five (56%) of the pregnant women reported feeling generally bad about episiotomy. One hundred and one (82.3%) of them hinted that they will not feel satisfied if they were given episiotomy with the reason that it ensures quick vaginal birth. The rate of episiotomy was higher than global recommended standards and primips are disproportionately affected. If organised by professional societies, more scientific conferences on limiting episiotomy might remedy this situation.

Ignoring international alerts? The routinization of episiotomy in France in the 1980s and 1990s.

As scientific evidence from the UK and the USA in the 1980s was questioning the usefulness of episiotomy, the rate in France increased from 38% in 1981 to 58.4% in 1996. In 1996, the World Health Organization recommended limiting the episiotomy rate to 10%. This article aims to examine this paradox through an analysis of the French medical debate on episiotomy during the 1980s and 1990s. Drawing on an analytical corpus composed of 192 articles published in French professional journals of obstetrician-gynaecologists and midwives, it shows that the majority of these health professionals considered episiotomy to be a preventive intervention. The most influential professional organizations and experts manage to refute most of the international alerts on the limitations and side effects of episiotomy through the constant production of new justifications and competing knowledge for the procedure. In the 1980s, episiotomy was seen as a means to prevent tearing and thus avoid perineal dysfunction. Episiotomy and perineal re-education (which developed into a new health sector) were put forward as ‘the’ solution to the problem. From the mid-1990s onwards, the focus shifted from the mother to the baby as episiotomy was promoted as a way to reduce the risk of newborn mortality and morbidity. This article shows that the alerts and controversies on the assumed iatrogenic effects of biomedical technologies and practices were silenced through efficient and dynamic production of competing knowledge about their assumed benefits.

Incidence, trends and risk factors for perineal injuries of low-risk pregnant women: Experience from a midwife run obstetric unit, South Africa.

Pregnant women experience perineal injuries during childbirth. The objectives of this cross-sectional retrospective study were to estimate the incidence, trends, and risk factors for perineal injuries of women who had childbirths from January 2013 to December 2017. We used logistic regression to identify risk factors for all injuries, episiotomy, and obstetric anal sphincter injury (OASI) measured by odds ratios (OR). A total of 5547 women showed gradual decreases of episiotomy from 17.6% in 2013 to 7.6% in 2017 (p <0.05). Perineal injuries were reduced from 33.3% in 2013 to 28.9% in 2017 (p <0.05). The risk factor for any perineal injury were younger ages, term pregnancy, and nil parity (p,0.05). Advanced gestational age, nil parity, and previous vaginal births were risk factors for episiotomy. However, birth weight of baby was significantly associated with OASI. Episiotomy and overall perineal injury rates were commendable. Training to midwives is needed to improve perineal care and maintain good practices during delivery.

Selective episiotomy versus no episiotomy – A clinical study on primigravida

Background: Episiotomy is the incision given over the pudendum, i.e. on the external genitalia organ during the vaginal delivery.&#x0D; Aims and Objective: In this study it has been tried to evaluate the benefits and the risks of selective episiotomy over spontaneous lacerations.&#x0D; Materials and Methods: This is an institution based interventional longitudinal study carried out in the Department of Obstetrics &amp; Gynaecology of College Of Medicine &amp; JNM Hospital, Kalyani over a period of 18 months in 218 patients (109 in each group) fulfilling the inclusion criteria. The recruitment and allocation in episiotomy and non-episiotomy groups were random after proper consent from the participants.&#x0D; Results: The frequency of postpartum perineal pain was around 47% in no episiotomy group and around 60% in selective episiotomy group. There were no cases of dehiscence, haematoma or wound infection in either of the groups. Around 96.22% of the women in the non-episiotomy group were satisfied or very satisfied compared to 89.52% in the selective episiotomy group.&#x0D; Conclusion: An episiotomy rate of less than 1% found in no episiotomy group as compared to around 18% episiotomy rate in selective episiotomy group. However, they have almost same feto-maternal outcome which successfully establish the effectiveness of no episiotomy practice over the selective one.

Induction of labour as compared with spontaneous labour in low-risk women: A multicenter study in Catalonia

ObjectiveTo compare birth and neonatal outcomes in low-risk women undergoing induced labour with those undergoing spontaneous onset. MethodsThis retrospective multicentre study included 30 public maternity hospitals in Catalonia between 2016 and 2017. The study population consisted of 5,717 women. ResultsOf the 5,717 births, 75.8% had spontaneous onset and 24.2% had an induction. Induced labour was more likely at week 41 of gestation and in nulliparous women. Induced labour increased the likelihood of undergoing caesarean section (adjusted OR [ORa], 2.59; 95% confidence interval [CI], 2.11–3.16), assisted vaginal birth (ORa, 1.70; 95% CI, 1.46–1.98), epidural analgesia (ORa, 2.64; CI, 2.14–3.27), postpartum haemorrhage (ORa, 1.56; 95% CI, 1.14–2.15) and episiotomy (ORa, 1.26; 95% CI, 1.08–1.47). Induced labour was also associated with not performing skin-to-skin contact with the mother (ORa, 0.47; 95% CI, 0.39–0.58) and with not performing early breastfeeding (ORa, 0.49; 95% CI, 0.39–0.61). ConclusionsThe frequency of labour inductions among low-risk women exceeds the level recommended by scientific organisations in Catalonia and Spain, and is associated with adverse birth outcomes such as increased caesarean section rates, assisted vaginal births, and episiotomy rates. It is also associated with the failure to perform early skin-to-skin contact with the mother and failure to initiate early breastfeeding.

Episiotomy practice and associated factors among mothers who gave birth at public health facilities in Metema district, northwest Ethiopia

BackgroundEpisiotomy is a surgical incision of the perineum to hasten the delivery. There is a scarce of information related to episiotomy practice, and its associated factors, in developing countries, including Ethiopia. Thus, this study was aimed to determine the level of episiotomy practice and to identify its determinants at public health facilities of Metema district, northwest, Ethiopia.MethodsInstitutional-based cross sectional study was conducted among 410 delivered mothers from March 1 to April 30, 2020. We recruited study participants using systematic random sampling technique. Data were entered to Epi data version 3.1 and exported to STATA version 14 for statistical analysis. Stepwise backward elimination was applied for variable selection and model fitness was checked using Hosmer and Lemshows statistics test. Adjusted odds ratio with the corresponding 95% confidence interval was used to declare the significance of variables.ResultsIn this study, the magnitude of episiotomy practice was found 44.15% (95% CI 39.32–48.97). Vaginal instrumental delivery (AOR 3.04, 95% CI 1.36–6.78), perineal tear (AOR 3.56, 95% CI 1.68–7.55), age between 25 and 35 (AOR 0.11, 95% CI 0.05–0.25), birth spacing less than 2 years (AOR 4.76, 95% CI 2.31–9.83) and use of oxytocin (AOR 2.73, 95% CI 1.19–6.25) were factors significantly associated with episiotomy practice.ConclusionsMagnitude of episiotomy practice in this study is higher than the recommended value of World Health Organization (WHO). Instrumental delivery, age, oxytocin, birth spacing and perineal tear were significant factors for episiotomy practice. Thus, specific interventions should be designed to reduce the rate of episiotomy practice.Plain English summaryThe routine use of episiotomy practice is not recommended by WHO. A study that compares routine episiotomy with restrictive episiotomy suggests that the latter is associated with less posterior perineal trauma, less need for suturing, and fewer complications related to healing. In addition, though, the rate of episiotomy has been declined in developed countries, still it remains high in less industrialized countries.The data for this study were taken at public health facilities of Metema district, northwest, Ethiopia. We included a total of 410 delivered mothers. The magnitude of episiotomy practice was found 44%. This result was higher than the recommended value of WHO. The WHO recommends an episiotomy rate of 10% for all normal deliveries.The result of this study showed that episiotomy practice is common among mothers whose age group are 18–24. In addition, mothers whose labor were assisted by instrumental vaginal delivery are more likely to have episiotomy as compared to those delivered by normal vaginal delivery. Laboring mothers who had used oxytocin were about three times more likely to be exposed for episiotomy than laboring mothers who did not use oxytocin drug. Moreover, episiotomy practice was nearly five times more likely among mothers who had birth spacing of 2 years and less as compared to mothers who had birth spacing of more than 2 years.

Perineal Body Length as a Predictor of Labor Progress

Background: Trauma to the genital tract does occur in about two thirds of women during the first and subsequent deliveries and the majority of these traumas require suturing. There is a continuous inverse relationship between the rate of episiotomy and the rate of spontaneous trauma. Perineal trauma is associated with a high prevalence of certain health problems. Perineal pain is the most significant with its impact on daily activities. Objective: The aim was to assess the relationship between the length of perineal body and mode of delivery, need for episiotomy and possibility of perineal and vaginal tears needing repair. Patients and Methods: This study was conducted at Maternity Hospital, Faculty of Medicine, Zagazig University. All patients were subjected to the following: Complete history taking, complete general examination and antenatal care. Procedure: The perineum was measured as the distance from the fourchette (the mid-point of the posterior edge of the vaginal interoitus at the muco-cutaneous junction) to the center of the anal orifice. Measurement was performed by trained research nurses using standard tape in dorsal lithotomy position. Results: This study showed that perineal tear, was present among 32.6% of the studied group.This study showed that need for episiotomy was 78.3%.The percentage of perineal tear was statistically lower among cases with perineal length > 4 cm than cases with perineal length 4 cm than cases with perineal length < 4 cm (64.7% and 86.2%). Women with shortened perineal body length (< 4 cm) had a higher chance of a perineal laceration. Conclusion: Longer perineum is associated with increase in the duration of the second stage of labor. The incidence of episiotomy and perineal tears were increased in patients with a perineal length of <4 cm.

Prevalence and meta-analysis of episiotomy in the Middle East

Introduction: Routine use of episiotomy is not recommended for women giving birth naturally. However, several studies in the Middle East have reported that it has high prevalence, but there is no general estimate. This study was performed with aim to review the prevalence and met-analysis of episiotomy in the Middle East based on studies conducted in this field. Methods: To search for articles, the databases of SID, Magiran, Medline, Science Direct, Scopus, Web of Science, Embase, ProQuest and google scholer search engines using the keywords of prevalence, epidemiology, frequency, incidence, rate and episiotomy in both languages of Persian and English and all possible combinations were searched with AND and OR operators. Calculation of heterogeneity of the studies was evaluated using I2 index and Bag test was used to examine the bias. Results: Twelve articles with a sample size of 69171 were reviewed. The overall prevalence of episiotomy was 67% (95% CI: 55-78). Using the random effect model, the risk of episiotomy in primiparous women was two times than multiparous women, which was statistically significant (RR = 2.01, 95% CI: 0.87-4.63, p <0.001; I2 = 99.99). Oxytocin use was also associated with an 80% (60-95%) prevalence of episiotomy. Conclusion: Due to the high rate of episiotomy in the Middle East, despite the standard set by the World Health Organization, there is an urgent need for planning to reduce this rate. Therefore, it is recommended to use effective methods to reduce the need for episiotomy in primiparous women and to avoid unnecessary clinical interventions such as using oxytocin.

Associations between maternal circulating 25-hydroxyvitamin D concentration and birth outcomes-Mode of delivery and episiotomy rate: A prospective cohort study.

AimThe objective of this study was to evaluate associations between maternal concentrations of 25‐hydroxyvitamin D (25(OHD)) and birth outcomes: mode of delivery and episiotomy rate.Design and MethodsOne hundred and seventeen pregnant women were enrolled in an observational, longitudinal, prospective cohort study. Multivariable linear regression analyses were performed to assess relationships between maternal 25(OHD) concentrations and mode of delivery. To account for systematic temporal variation in 25(OHD), a cosinor model to the data was fitted.ResultsNo significant statistical associations were found between adjusted maternal 25(OHD) concentrations and risk of eutocic vaginal delivery, instrumented delivery (OR 1.05 [95% CI: 0.97–1.13]), primary Caesarean section (OR 0.99 [95% CI: 0.88–1.11]) or Caesarean section for any other causes (OR 1.04 [95% CI: 0.95–1.14]). High 25(OHD) levels tended to show a protective effect on performance of episiotomy, without reaching statistical significance (OR 0.36 [95% CI: 0.09, 1.37]).

Episiotomy and Its Complications

Objectives: This study aimed to evaluate the frequency of episiotomy and its early complications in natural vaginal delivery in the maternity ward of Ali Ibn Abitaleb (AS) Hospital in Zahedan from 2014 - 2016. Methods: In this cross-sectional study, which was conducted in 2017, the archives of women who gave birth between 2014 - 2016 were reviewed. Data were collected using information forms and analyzed by SPSS software. Results: Of 418 women were reviewed, the episiotomy rate was 54.5%; there was a significant association between parity and mother age with episiotomy rate. Moreover, 24-hour pain frequency, perineal rupture rate, hematoma rate was significantly higher in the episiotomy group. First- and fifth-minute Apgar of the neonates in the episiotomy group was significantly lower. Conclusions: In overall, the episiotomy rate was 54.5%, and there was a significant association between parity and mother age with episiotomy rate.

Knowledge, attitude and experience of episiotomy practice among obstetricians and midwives: a cross-sectional study from China

ObjectiveEpisiotomy is still performed widely by obstetricians and midwives in some Chinese maternity units, but the reasons are unknown. This study aims to determine the knowledge, attitude and experience towards...

Effects of Obstetric Interventions During Labor on Birth Process and Newborn Health.

AIMThis study aimed to investigate the effects of the interventions in the delivery room on the delivery process and the newborn health.METHODThe analytical-cross-sectional study was carried out with 354 puerperal women who gave birth in hospital between December 2016 and June 2017 in a public hospital. The data were collected by the data collection form developed by the researchers. Data analysis was done by using descriptive statistics and chi-square test in SPSS 21.00 program.RESULTSThe interventions were determined in continuous electro fetal monitoring (80.5%), oxytocin induction (79.9%), restriction of free movement (56.8%), amniotomy (49.7%), enema (44.1%), and movement restriction (56.8%). The intervention period of the second phase of delivery was longer and the rate of cesarean section was higher, and the need for NICU, suction difficulty, 5th APGAR score less than 7, trauma development, difficulty in suction, and higher trauma rates were found in infants. It was determined that the rate of oxygen need in puerperals admitted to the delivery room with cervical dilatation below five cm, vacuum and episiotomy applications in those who underwent amniotomy, and vacuum application rates in those undergoing oxytocin inductions were found to be high. In addition, the rate of fundal compression and episiotomy was significantly higher in patients who used continuous electro fetal monitoring, fundal compression and vacuum rate in patients who were administered analgesic drugs, and episiotomy rates in patients using analgesic drugs.CONCLUSIONIt has been concluded that interventions in the first phase of labor negatively affect the delivery process and neonatal health and increase the need for intervention in the second phase.

Clinical evaluation of electrohysterography as method of monitoring uterine contractions during labor: A propensity score matched study

ObjectiveElectrohysterography is a non-invasive technique to monitor uterine activity and has a significantly higher sensitivity compared to conventional external tocodynamometry. Whether this technique could lead to improved obstetrical outcomes is still unknown. In this propensity score matched study, clinical results of the first pilot implementing electrohysterography during labor were evaluated. The hypothesis tested is that electrohysterography will help to optimize uterine activity and thereby lead to fewer obstetric interventions. Secondary outcomes were Apgar score, arterial umbilical pH values, first stage labor duration, episiotomy rate and postpartum vaginal blood loss. Study designFrom November 2017 until October 2018, electrohysterography was introduced as a standard alternative for monitoring uterine activity in high-risk deliveries. It could be applied in case of induced labor, previous cesarean delivery, body mass index ≥30 kg/m2 or an inadequate external tocodynamometry monitoring. Outcomes were compared to a matched group of women in which external tocodynamometry was applied for uterine activity monitoring during labor. These women were identified using propensity scores. ResultsA total of 348 women received electrohysterography as standard method of uterine monitoring during labor. A match (1:1 ratio) was found for 317 women, resulting in a total population of 634 women. No significant differences were seen in obstetric interventions (i.e. cesarean deliveries and assisted vaginal deliveries) between the electrohysterography and tocodynamometry group (P = 0.80). No statistically significant differences were seen regarding the secondary outcomes. ConclusionsThis first pilot study implementing electrohysterography as monitoring method during labor in a high-risk population did not result in statistically significant differences regarding obstetric interventions, low Apgar scores or low umbilical artery pH values. Therefore, we suggest that electrohysterography causes no harm and we recommend further implementation and evaluation in clinical practice.

Situation Analysis of Episiotomy in the Gulf: A Scoping Review

Objective: To assess episiotomy rates and indications in Gulf Council Countries (GCC).Materials and Methods: Two databases (PubMed, Google Scholar) were searched for relevant papers published from January 2014 to December 2019. Only 9 articles (3 in Saudi Arabia, 2 in Iraq and 1 in Oman, 1 in Qatar, 2 in UAE) were eligible. All articles reported episiotomy rates and indications as a primary or secondary outcome.Results: The cumulative rate of episiotomy in GCC was 52%, while this was 45% in Saudi Arabia. The Perineal tear reported rate in GCC was 29%, however, the cases accompanied with episiotomy was 65%. The most frequent indication was rigid perineum in both 16.9% in Saudi Arabia and 65.5% in Iraq.Conclusion: Episiotomy rates were reported to be high in GCC and Saudi Arabia. Only few articles reported episiotomy from the GCC. The commonly reported indications were both subjective for the doctor or the patient. We recommend that episiotomy rates with clear indications should be investigated in future research.International Journal of Human and Health Sciences Vol. 05 No. 03 July’21 Page: 286-291