Prevalence Of Episiotomy Research Articles

Prevalence of episiotomy and associatedfactors in a highly complex institutionin Cali, Colombia, 2022

Introduction: episiotomy is a common but not routine obstetric procedure during delivery care, which over the years has increased. Objective: to determine the prevalenceof episiotomy and associated factors in a high complexity institution. Methods: crosssectional study with analytical component, including pregnant women with delivery care during the first semester of the year 2022 in a high complexity clinic in Cali, Colombia.Random sampling was performed with an N 343 deliveries and an error of 4.1%. Relative frequencies were estimated with a 95% CI and measures of central tendency and dispersion according to the distribution of the variable. To evaluate the association andadjust for confounding factors, multiple logistic regression was performed. Results: the prevalence of episiotomy was 37.4% (95% CI: 32.4% - 42.6%), 13.3% (IC 95%: 8.5% -19.7%) in multiparous women and 54.5% (IC 95%: 47.6% - 61.3%) in nulliparous women.The risk factors were: nulliparity OR 8.56 CI 95% (4.6 - 15.9), while protective factorswere identified as: low birth weight OR 0.21 CI 95% (0.05 - 0.82), grade I tear OR 0.08CI 95% (0.03 - 0.22) and grade II tear OR 0.17 CI 95% (0.08 - 0.034). Conclusion: the rate of episiotomy was 37.4%, which is outside the parameters established by theWorld Health Organization, so it is necessary to carry out educational interventions forhealth professionals to reduce these figures.

Frequency of episiotomy practice in an institution in Quito, Ecuador 2009-2022

To determine the prevalence of episiotomy over a 14-year period and to explore its association with maternal, delivery, and neonatal variables using administrative data. This is a cross-sectional study. Women who had a vaginal delivery with a live newborn at a referral hospital for obstetric care in Ecuador were included. Consecutive sampling was employed. ICD-10 records and the perinatal information system (PIS) were utilized. Sociodemographic, gestational, delivery, and neonatal variables were assessed. Descriptive analysis was performed. The overall and yearly prevalence was determined. Exploratory bivariate and multivariate analyses were conducted. The study was approved by the Human Research Ethics Committee of the Universidad Central del Ecuador. A total of 11,862 records were analyzed. The overall prevalence of episiotomy was 36.69 %, with a maximum of 42 % and a minimum of 28 %. There is an implied trend towards a reduction in frequency from 2019 to 2022. A positive association was found between episiotomy and maternal age under 20 years, previous cesarean section, absence of a companion during delivery, term newborns, and large for gestational age newborns. A negative association was found with previous vaginal deliveries. The prevalence of episiotomy exceeds the recommendation of the World Health Organization (WHO). Clinical practice guidelines should consider potentially modifiable maternal and neonatal factors in their recommendations. Prospective studies should be conducted to evaluate the safety of the procedure, confirm these observations, and use robust methodologies to assess if there is a real decrease in its practice.

Prevalence of episiotomy and associated factors among women who gave birth at public health facilities in Jigjiga town, eastern Ethiopia: A cross-sectional study.

Maternal morbidity and mortality has remained a major public health concern worldwide. Basic emergency obstetric care is the primary intervention to prevent obstetric complications and maternal death. Episiotomy is one of the basic obstetrical procedures used to facilitate vaginal delivery, shorten the second stage of labor and prevent complications. However, there is a paucity of evidence on the prevalence and factors associated with episiotomy among women who gave birth in eastern Ethiopia. This study aimed to determine the prevalence of episiotomy and its associated factors among women who gave birth at public health facilities in Jigjiga town, eastern Ethiopia. A facility-based cross-sectional study was conducted among women who gave birth vaginally from May 1 to June 30, 2022. A total of 422 study participants were recruited using systematic random sampling. Data were collected using structured questionnaires through a face-to-face interview supported with standard observational checklist and reviewing medical records. A logistic regression analysis was carried out to examine the association between explanatory variables and episiotomy. An adjusted odds ratio (AOR) at a 95% confidence interval (CI) at a P-value <0.05 was used to declare significant association. The prevalence of episiotomy among women was 52.6% (95% CI: 47.8%, 57.0%). Obstetric complications during current pregnancy (AOR:3.92, 95% CI: 1.59, 9.68), birth weight ≥4000 gm (AOR: 4.30, 95% CI: 1.53, 12.04), induction of labor (AOR: 3.10, 95% CI: 1.62, 5.93), meconium-stained amniotic fluid (AOR:2.10, 95% CI: 1.14, 3.88), duration of the second stage of labor ≥90 minutes (AOR:3.09, 95% CI: 1.53, 6.23), instrumental delivery (AOR: 2.69, 95%, CI: 1.39, 5.19), and female genital mutilation (AOR: 2.91, 95% CI: 1.83, 4.64) were factors significantly associated with episiotomy. Slightly more than half of the women who gave birth at public health facilities in the study area underwent episiotomies. In addition to the common obstetric factors, having a female genital mutilation scar increased the risk of women's experiencing episiotomies. Therefore, intervention should be tailored to address the identified obstetric risk factors and avoid female genital mutilation in the community to reduce women's experiences of episiotomies in the future.

Promoting Respectful Maternity Care by Reducing Unnecessary Episiotomies: Experiences from Centers of Excellence for Breastfeeding in Vietnam.

(1) Background: Routine episiotomy is not recommended by international guidelines; however, it occurs at a high rate in Vietnam. (2) Methods: A process to reduce unnecessary episiotomies was developed and implemented as part of the Centers of Excellence for Breastfeeding initiative, which aims to deliver high-quality breastfeeding and early essential newborn care services within a supportive policy environment. The aim of this project report is to outline the steps undertaken to reduce episiotomies, the experience in pilot hospitals, and the process towards changing policy. (3) Results: During the 14 months following the change in episiotomy policy, pilot hospital records showed no infant death or injury. Monthly monitoring data from four pilot hospitals showed that the prevalence of episiotomy was substantially lower than the average in national hospitals in Vietnam. Facilitators to reducing the episiotomy rate include the incentive of Centers of Excellence for Breastfeeding designation and supportive hospital leadership. Challenges include the ambiguity of Vietnam's national guideline on episiotomy and lack of routine monitoring on the episiotomy rate and indications. (4) Discussion: Our experience suggests that through training and routine monitoring hospitals can apply a policy of selective episiotomy and reduce the practice, particularly among multiparous women, and improve breastfeeding rates.(5) Conclusions: Sharing our experience of implementing this process and offering four areas for action will hopefully contribute to expanded use of mother-friendly, evidence-based care as policy and routine practice in Vietnam and similar settings.

Prevalence of Episiotomy and its Associated Factors among Mothers Who Gave Birth at Public Health Facility in Gondar City, Northwest Ethiopia: A Cross-Sectional Study

Prevalence of Episiotomy and its Associated Factors among Mothers Who Gave Birth at Public Health Facility in Gondar City, Northwest Ethiopia: A Cross-Sectional Study

Episiotomy in Southern Brazil: prevalence, trend, and associated factors.

ABSTRACTOBJECTIVE To identify and analyze the prevalence, trend, and factors associated with episiotomy in Rio Grande, in the state of Rio Grande do Sul, Southern Brazil.METHODS A single, standardized questionnaire was applied to all pregnant women, residents in the municipality of Rio Grande, who had children in local hospitals between January 1 and December 12 of the years 2007, 2010, 2013, 2016 e 2019. Demographic and socioeconomic characteristics were investigated, as well as the assistance received during pregnancy and delivery. Chi-square test was used to compare proportions and Poisson regression with robust variance adjustment was used for multivariable analysis. Prevalence ratio (PR) was used as effect measure.RESULTS Among the 12,645 births that occurred in the five years, 5,714 (45.2%) were vaginal delivery. Of these mothers, 2,930 (51.3%; 95%CI: 50.0%–52.6%) underwent episiotomy. Over this period, the episiotomy rate decreased from 70.9% (68.4–73.5) in 2007 to 19.4% (17.1–21.7) in 2019. Adjusted analysis showed a high PR of episiotomy occurrence among women who were young (PR = 2.23; 95%CI: 1.89–2.63), had higher education (PR = 1.21; 95%Cl: 1.03–1.42), had a higher family income (PR = 1.25; 95%CI: 1.10–1.41), were primiparous (PR = 3.41; 95%CI: 2.95–3.95), had prenatal care in the private sector (PR = 1.25; 95%CI: 1.07–1.46), had oxytocin-induced labor (PR = 1.18; 95%CI:1.09–1.27), underwent forceps (PR = 1.32; 95%CI: 1.16–1.50), and whose newborn weighed 4,000 g or more (PR = 1.43; 95%CI: 1.14–1.80).CONCLUSION Although the prevalence of episiotomy fell sharply within the studied period, its occurrence is more likely among women at lower risk of birth complications.

EPISIOTOMY – TRENDS AND PREVALENCE IN HEALTH CENTER VRANJE FOR THE PERIOD 1996 – 2021. YEAR

With this paper, we wanted to determine the prevalence of episiotomy in the completion of childbirth in the Gynecology and Obstetrics Department of the General Hospital in Vranje in the twenty-five-year period (1996-2021), and this is the period since it is recommended to abandon routine episiotomy. We also wanted to compare the obtained results with the results of similar studies by other authors and thus determine whether the general trend of reduced use of this obstetric operation due to the numerous complications that its use causes, exists in our country. Retrospective analysis includes data obtained from birth protocols with special reference to patients born vaginally and their parity. Childbirth completed using a vacuum extractor and caesarean section were analyzed separately. Such births for the first and last year of the examined period were presented and analyzed (1996, 2021). Aggregate data for both years were also analyzed. The obtained results are expressed numerically and presented using tables. Based on the data, it was concluded that the total number of births decreased, that the number of cesarean sections increased, that episiotomy in vaginal delivery was the most common among primiparous women and that episiotomy was significantly higher in our sample than in other studies.

Episiotomy at the Asha’ab obstetric emergency center, Aden, Yemen: Prevalence, clinical profile, and complications

Background and Objectives: Despite the controversies that prevail regarding the efficacy of episiotomy, it is still practiced widely around the world in various degrees of prevalence. This study aimed to identify and analyze the prevalence, clinical profile, and complications of episiotomy performed on women who delivered at the Asha’ab Obstetric Emergency Center. Patients and Methods: This was a cross-sectional study that involved women who had undergone vaginal delivery at the Asha’ab Obstetric Emergency Center, in Aden city, Yemen, between October 1, 2021, and March 31, 2022. Permission to conduct the study was obtained from the center’s administrative office. Results: During the study period, 858 women delivered vaginally at our center. Out of these, 443 women had had an episiotomy, representing an episiotomy prevalence of approximately 51.6%. These 443 women were enrolled in this study. The episiotomy was more common among primigravida women (n=362, 81.7%), followed by multiparous women (n=42, 9.5%). The most commonly associated medical disorder was anemia (n=167, 37.7%), followed by hypertension (n=33, 7.4%). Perineal pain (n=51, 11.5%) was the most frequently reported post-episiotomy complication, followed by perineal discomfort (n=32, 7.2%), wound infection (n=27, 6.1%), perineal bleeding (n=18, 4.1), difficulty in walking (n=9, 2.0%), wound dehiscence (n=3, 0.7%), and difficulty in defecation (n=1, 0.2%). Conclusion: The prevalence of episiotomy among women who gave birth at the Asha’ab Obstetric Emergency Center, in Aden city, Yemen, was higher than the World Health Organization recommendation, which is around 10% or less with acceptable obstetric evidence indicating the need. Further prospective large-scale studies are recommended to confirm the findings of this study. Keywords: Episiotomy, Post-episiotomy complications, Prevalence, Vaginal delivery, Yemen.

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.

Prevalence and Determinants of Episiotomy: Cross Sectional Survey

Introduction: Episiotomy is one of the most common procedures in obstetrics; defined as perineum enlargement incision during the second stage of labor to increase the diameter of vaginal outlet to facilitate baby birth. Restrictive episiotomy involves performing an episiotomy only when there is an indication. The 2018 WHO episiotomy policy recommend to avoid routine or liberal use of episiotomy for women undergoing spontaneous vaginal birth. However, high prevalence of episiotomy are reported in developing countries and there is limited assessments in the study area. Methods: Cross sectional study design was employed to assess the prevalence and determinants of episiotomy in St.Paul’s Hospital, Addis Ababa, Ethiopia. The study included all vaginal deliveries from July- June2016 in the hospital. Medical charts for 344 deliveries in the selected period were reviewed for analysis. Systematic sampling was followed to employ study participants. Data were cleaned and analyzed using the Statistical Package of Social Sciences (SPSS) version 23.0 for Windows. Means, Percentages and Ratios were be calculated and cross tabulation used to compare different variables and subjected to Chi-square analysis to assess various relationships with a significance level of P < 0.05. Result: A total of 344 women who had a vaginal delivery were included in the study. The age of the women ranges from 18-40 years, with the mean age of 25.53 (SD± 4.601) years. The prevalence of episiotomy was 41.9%. Binary logistics analysis showed statistically significance relationship between practice of episiotomy with parity (P<0.001) and place of ANC follow up (P=0.019), with duration of second stage of labour (P=0.001) and weight of the new born (P<0.001). Conclusion: The study indicated high prevalence of episiotomy practice compared to the WHO recommended restrictive practice. Guidelines and evaluation of the practice has to be in place to improve the safe practice of episiotomy in the institution. DOI: 10.7176/JMPB/69-02 Publication date: March 31 st 2021

Prevalence of Episiotomy and Its Associated Factors in University of Gondar Comprehensive Specialized Referral Hospital: A Retrospective Study from Ethiopia

Background: Episiotomy is a surgical incision of the perineum during delivery to enlarge the vaginal orifice. It is one of the most commonly performed obstetric intervention world widely. The magnitude of episiotomy varies from population to population. Limited information exists related to the practice of episiotomy in Ethiopia. This study aimed to assess the prevalence of episiotomy and its associated factors in University of Gondar Comprehensive Specialized Referral Hospital, Ethiopia. Methods: Institution based retrospective cross-sectional study was undertaken from March to June 2014 on 306 mothers who had a vaginal delivery in the Hospital. Systematic random sampling technique was employed to select study units. The data were collected using pretested cheek list. Proportion of patients who had episiotomy was calculated and the association between dependent and independent variables was checked using both binary and multiple logistic regression and Chi-square. Results: Prevalence of episiotomy in University of Gondar Comprehensive specialized Referral Hospital was 47.7% (n = 146). Majority (89.5%) of the delivery was spontaneous vaginal delivery while vacuum, forceps and destructive delivery were 4.6%, 4.6%, and 1.3% respectively. During pregnancy and delivery, 84% of mothers had no associated diseases while 8% had hypertensive disorder, 5% diabetes mellitus and 3% of them has other diseases. After multivariate analysis episiotomy was significantly associated with maternal age (15-24 years) (p = 0.041, AOR (CI 95%) 1.65 (1.02 - 2.66)), primiparity (p =0.010, AOR (CI 95%) 2.61 (1.54 - 4.44)), prolonged labor (p = 0.001, COR (CI 95%) 6.45 (2.89 - 14.38)), and weight of newborn (p = 0.044, COR (CI 95%) 2.48 (1.16, 5.31)). Conclusion: Prevalence of episiotomies in the institution was 47.7% and variables that remained associated significantly with episiotomy were maternal age, primiparity, prolonged labor, and newborn weight.

PREVALENCE OF EPISIOTOMY AND FACTORS ASSOCIATED WITH PRACTICE OF EPISIOTOMY AT SAINT PAUL’S HOSPITAL MILLENNIUM MEDICAL COLLEGE: A CROSS SECTIONAL STUDY

ABSTRACTINTRODUCTION: Episiotomy is a surgical incision made on the perineum to widen the vaginal opening for delivery. Although rate of episiotomy decreased, it is still one of the most commonly performed procedures in obstetrics (1). OBJECTIVE: The objective of the study is to determine the prevalence of episiotomy and identify risk factors associated with the practice of episiotomy at (Saint Paul’s Hospital Millennium Medical College) SPHMMC. METHODOLOGY: Hospital-based cross-sectional study was conducted from February 1/2016 to July 1/2016. All mothers who gave birth vaginally were included in the study. Data was entered in to epi info version 7 and exported into SSPS statistical package version 16 and analyzed. Both bivariate and multivariate analysis were used to see the association of the dependent and independent variables with p-value &lt;0.05 considered statistically significant. RESULT: A total of 405 participants were included in the study. The prevalence of episiotomy was 65.4%. Both Bivariate &amp; Multivariate analysis showed that nulliparity, duration of second stage of labor more than 90-minute, instrumental delivery, assisted breech delivery &amp; birth weigh more than 4,000 gm were strongly associated with episiotomy (p- value &lt; 0.005). CONCLUSIONS AND RECOMMENDATIONS: The prevalence of episiotomy (65.4%) at SPHMMC is higher than the findings in other studies in Ethiopia &amp; the WHO’s recommendation of 5- 10%. Nulliparity, duration of second stage of labour more than 90 minutes, instrumental &amp; breech vaginal deliveries and birth weight of more than 4000 gm were independent risk factors for episiotomy. KEYWORDS: Episiotomy, prevalence, risk factors

Prevalence and Risk Factors of Episiotomy and Perineal Tear in the Maternity Teaching Hospital of Erbil City, Iraq

Background and Objectives: During childbirth, women are at risk for experiencing perineal trauma to the genitalia resulting in a tear of the perineum or the surgical process of an episiotomy. Knowing the prevalence and the risk factors associated with perineal trauma may help in the reduction of episiotomy and prevention of occurrence of tear. The aim of the study was to find out the prevalence and risk factors associated with perineal trauma among women ages 15-48.Methods: A cross-sectional study was conducted in the Maternity Teaching Hospital of Erbil, Kurdistan region, Iraq. All records of mothers (n = 1500) who had been admitted to the delivery room for vaginal delivery during the month of May (2015) were reviewed. Chi-square test of association and binary logistic regression were used to interpret the data.Results: The overall rates of episiotomy, tear, their combined presence, and an intact perineum were: 47.8%, 7.2%, 26.1% and 18.9%, respectively. Incidence of having an episiotomy, tear, or combination of both, were significantly associated with women of young ages and women who were primigravida parity. There was a statistically significant association between high birth weight and the occurrence of perineal trauma. There was no association between perineal trauma and residency (urban/rural), occupation, gender of baby and time of delivery. Binary logistic regression analysis showed that having an episiotomy increased the risk of a tear by more than 30%.Conclusions: The prevalence of episiotomy was found to be 73.9% which is much higher compared to the World Health Organization recommendation which is 10%. Perineal trauma were associated with factors such as age, parity, and birth weight. Episiotomy is a risk factor for a vaginal tear. We recommend further research to inform the development and implementation of restrictive episiotomy policies to reduce and prevent occurrences of perineal trauma.

Risk factors for episiotomy during vaginal childbirth: A retrospective cohort study in Western China.

To assess the incidence rates and risk factors for episiotomy during vaginal childbirth in a Western China context. A retrospective hospital-based cohort study was conducted using computerized data of 3721 singleton vaginal deliveries after 28weeks of gestation. Women who underwent episiotomy were compared with those who did not. The overall prevalence of episiotomy was 44.0% (1636/3721); 52.9% (1458/2756) among primiparas and 18.4% (178/965) among multiparas (P<0.001). Adjusted risk factors significantly associated with episiotomy included primiparity, prolonged second stage of labor, and labor-management personnel. Risk factors specific to primiparas were increasing maternal age (per year) (OR=1.04, 95% CI 1.01 to 1.07, P=0.035), increasing biparietal diameter (per centimeter) (OR=1.40, 95% CI 1.06 to 1.84, P=0.017), first stage of labor beyond 10-hour (OR=1.36, 95% CI 1.10 to 1.68, P=0.005), and birth weight (per 100g) (OR=1.06, 95% CI 1.03 to 1.09, P<0.001). Birth weight resulted in an adjusted risk increase of 6.1% among primiparas for every 100 additional grams of birth weight. For the analysis stratified by labor-management personnel, moderately experienced midwifery was a risk factor of episiotomy (OR=1.76, 95% CI 1.21 to 2.56, P=0.003); midwives with bachelor's degree (OR=1.47, 95% CI 1.15 to 1.88, P=0.002), and obstetricians with doctor's degree (OR=2.00, 95% CI 1.18 to 3.39, P=0.010) were most likely to perform episiotomy. Episiotomy is still commonly performed in Western China. A survey of maternity care professionals' knowledge of and attitudes towards episiotomy is urgently required to explore the complex reasons for conducting episiotomy.

Prevalence of Episiotomy and Perineal Lacerations in a University Teaching Hospital, North-Central Nigeria

Episiotomy is an incision on the introitus and the perineum to increase pelvic outlet to facilitate childbirth and prevent trauma to fetal and maternal tissues. Episiotomy and perineal laceration may predispose the woman to short and long term complications. The objective of this study was to determine the prevalence of episiotomy and perineal lacerations and their associated risks factors at Benue State University Teaching Hospital, Makurdi, Nigeria. Retrospective data of all women who had spontaneous vagina delivery over a 3 year period with perineal laceration/episiotomy were reviewed. Data was obtained from the records and information on the socio-demographic variables, episiotomies, lacerations and the birth weight of infants. The associated risk factors were recorded using Statistical Package for Social Sciences version 22.Of the 636 vaginal deliveries, 85(13.4%) had lacerations with 65(10.2%) first degree, 19(3.0%) second degree and 1(0.2%) major laceration. Episiotomy rate was 132(20.8%). The mean parity and birth weight of infants were 2.62(SD= ± 1.83) and 3.1 kg (SD= ± 0.767) respectively. The highest number of perineal tears 69(10.8%) were in the lower age group (≤ 30 years). A similar observation was noted in respect of episiotomies which rate however decreased with parity. The relationship between maternal age, parity, booking status, fetal weight and the perineal status at delivery was statistically significant (P≤ 0.05). Episiotomy and perineal laceration rates in our institution were low. The major risk factors were low parity, young maternal age and increasing fetal weight at birth and their presence should be an early warning sign. We advise perineal support for all women during delivery.

Perineal injuries and birth positions among 2992 women with a low risk pregnancy who opted for a homebirth.

BackgroundWhether certain birth positions are associated with perineal injuries and severe perineal trauma (SPT) is still unclear. The objective of this study was to describe the prevalence of perineal injuries of different severity in a low-risk population of women who planned to give birth at home and to compare the prevalence of perineal injuries, SPT and episiotomy in different birth positions in four Nordic countries.MethodsA population-based prospective cohort study of planned home births in four Nordic countries. To assess medical outcomes a questionnaire completed after birth by the attending midwife was used. Descriptive statistics, bivariate analysis and logistic regression were used to analyze the data.ResultsTwo thousand nine hundred ninety-two women with planned home births, who birthed spontaneously at home or after transfer to hospital, between 2008 and 2013 were included. The prevalence of SPT was 0.7 % and the prevalence of episiotomy was 1.0 %. There were differences between the countries regarding all maternal characteristics. No association between flexible sacrum positions and sutured perineal injuries was found (OR 1.02; 95 % CI 0.86–1.21) or SPT (OR 0.68; CI 95 % 0.26–1.79). Flexible sacrum positions were associated with fewer episiotomies (OR 0.20; CI 95 % 0.10–0.54).ConclusionA low prevalence of SPT and episiotomy was found among women opting for a home birth in four Nordic countries. Women used a variety of birth positions and a majority gave birth in flexible sacrum positions. No associations were found between flexible sacrum positions and SPT. Flexible sacrum positions were associated with fewer episiotomies.

The Effect of Warm Compress Bistage Intervention on the Rate of Episiotomy, Perineal Trauma, and Postpartum Pain Intensity in Primiparous Women with Delayed Valsalva Maneuver Referring to the Selected Hospitals of Shiraz University of Medical Sciences in 2012-2013.

Genital trauma during vaginal delivery may result from episiotomy, spontaneous perineal tears (perineum, vagina), or both. In 2012, this study aimed to investigate the effect of warm compress bistage intervention on the rate of episiotomy, perineal trauma, and postpartum pain intensity in the primiparous woman with delayed Valsalva maneuver. In this randomized clinical trial, which was performed in hospitals in Shiraz, Iran, in 2012-2013, 150 women were randomly divided into 2 groups: 1 intervention and 1 control. The intervention group received warm compress bistage intervention at 7-cm and 10-cm dilatation and zero position during the first and second stages of labor for 15 to 20 minutes, whereas the control group received the hospitals' routine care. After delivery, the prevalence of episiotomy; intact perineum; location, degree, and length of rupture; and postpartum pain intensity were assessed in the 2 groups. Following that, the data were analyzed with SPSS statistical software (version 16) using χ test, t test, and odds ratio. The results revealed a significant difference between the intervention and control groups regarding the frequency of intact perinea (27% vs 6.7%) and the frequency of episiotomy (45% vs 90.70%). In addition, the frequency of the location of rupture (P = .019), mean length of episiotomy incision (P = .02), and mean intensity of pain the day after delivery (P < .001) were significantly lower in the intervention group compared with the control group. However, the rate of ruptures was higher in the intervention group. Warm compress bistage intervention was effective in reducing episiotomies and the mean length of episiotomy incision, reducing pain after delivery, and increasing the rate of intact perinea. However, the rate of ruptures slightly increased in the intervention group compared with the control group.

Prevalence and predictors of episiotomy among women at first birth in enugu, South-East Nigeria.

Background:Women having their first birth have a higher risk of episiotomies. Therefore, the study of the procedure in this group of at risk women will assist in solving some of its associated controversies.Aim:The aim was to determine the prevalence, predictors, and outcomes of episiotomy among primigravid women in Enugu, Nigeria.Materials and Methods:The study was a retrospective cross-sectional review of labor ward records of women that had their first delivery at the University of Nigeria Teaching Hospital (UNTH) Enugu, over a 5-year of April 204 to March 2009. Only women that had a vaginal delivery were included in the study. Mann–Whitney U-test (continuous data) and Chi-square test (categorical data) were used for data analysis.Results:Prevalence of episiotomy in the study was 62.1% (411/662). The episiotomy rate for booked women (65.6%, 376/573) was significantly higher than that of unbooked women (39.3%, 35/89), (prevalence ratio = 1.67 [95% confidence interval: 1.28, 2.17]). The birth weights of babies delivered in the episiotomy group (median = 3.2 kg [interquartile range (IQR): 2.9-3.5]) was statistically higher than those of women who did not receive episiotomy (median, 3.1 kg [IQR: 2.7-3.4]), (Z = -3.415, P = 0.001). Proportion of newborns with low 1st min Apgar scores in the episiotomy group (21.7%, 89/411) was significantly lower than the no episiotomy group (15.1%, 38/251) (P = 0.04).Conclusion:Prevalence of episiotomy among women that had their first births in the UNTH, Enugu was high, and the predictors included booked status of women, higher gestational age at delivery, and larger neonatal birth weight. More efforts should be made to reduce episiotomy rate in the hospital.

Episiotomy in Nigeria

Objective: To review the incidence and complications associated with episiotomy and perineal tears at the University of Benin Teaching Hospital, Benin City, Nigeria. Method: A retrospective review of all vaginal births conducted in the hospital between January 1997 and December 1998 was undertaken. Vaginal births (1345) were reviewed. Result: The prevalence of episiotomy in the hospital during the period was 46.6%. Over 90% of primigravid parturients had episiotomy. The incidence of episiotomy decreased with increasing parity, while the incidence of spontaneous vaginal tears increased with parity. As compared with perineal tears, episiotomy was associated with a statistically significant increased risk of wound breakdowns requiring secondary resuturing. When controlled for parity, breech births, forceps and vacuum delivery were more likely to lead to episiotomy, compared to spontaneous vertex delivery occurring at term. Conclusion: A policy of systematic reduction in the incidence of episiotomy can be pursued in this hospital. Greater attention needs to be paid to selection of women to undergo episiotomy, the prevention of spontaneous perineal tears and the care of episiotomy wounds in this institution.