Routine Episiotomy Research Articles

Ensuring ethical maternal care: Addressing episiotomy trends in Pakistan.

Madam, The use of routine episiotomies, particularly those performed without consent, is a concerning and escalating trend during childbirth in Pakistan. An Episiotomy is a surgical incision in the pelvic floor to enlarge the vaginal opening during labour. The incision is performed under local anaesthetic with scissors. It is deemed necessary only under certain conditions: abnormal progression of labour, suspected foetal distress, vacuum or forceps childbirth, and shoulder dystocia.1,2 Despite the WHO’s recommendation of an episiotomy rate of less than 10% to be considered safe, the rates are disproportionately high in Pakistan. This prompts the need for improved maternal care that is responsible, accountable, and consensual.3 The need for respectful maternal care is crucial in Pakistan. A study conducted in Rawalpindi analysed data from 124798 deliveries and found an 80% incidence of routine episiotomies during normal vaginal deliveries in primigravida cases.3 Another cross-sectional study conducted in Karimabad on 235 patients, also revealed an alarming prevalence of episiotomies, with a rate of 78%.4 These rates differ significantly from those of other countries, such as 17% in New Zealand and 36.5% in Norway, underscoring the potential overuse of episiotomies beyond medical need in Pakistan. Cultural beliefs and a lack of adequately trained staff likely exacerbate this disparity.2,3 Furthermore, increasing episiotomy rates can adversely impact emotional well-being, cause perineal trauma, difficulty in breastfeeding, infection, and delayed healing.2 The intensity of these impacts and the high incidence of episiotomy highlight the need for comprehensive reforms in maternal care practices to ensure the safety and well-being of women. To address this issue, it is imperative to adopt a multifaceted approach that prioritizes informed consent and aims to curb the increasing trend of episiotomies. A commonly presumed benefit of an episiotomy is the prevention of advanced tears; yet, a randomized control trial on 676 patients found no association between decreased use of episiotomy and significant prevalence of severe tears.5 This stresses the need to shift to a policy of selective episiotomies like that implemented in Vietnam. The approach encompasses allocating a budget for routine training of staff, regularly recording rates of episiotomy/tears and including updated guidance about the use of episiotomies within the curriculum.2 Furthermore, when performing an episiotomy patients must be fully informed and individually consented, written or verbal. Opt-out consent may apply in emergencies.1 Such interventions can help ensure higher maternal care standards within Pakistan.

Levator Ani Muscle Avulsion After Vaginal Delivery Comparing Routine Versus Restrictive Episiotomy: A Pilot Study.

The objective was to compare the rate of levator ani muscle avulsion following vaginal birth after routine and restrictive episiotomy. This study consists of two cohorts of pregnant women prospectively enrolled between September 2015 and December 2017 at a university hospital. The pregnant women were subject to a randomized controlled trial, in which participants received a restrictive episiotomy protocol versus a routine episiotomy protocol for vaginal delivery. Levator ani avulsion was evaluated by four-dimensional ultrasound screening. Sixty-one post-partum primipara women were enrolled in our study. Thirty-two women (52.5%) had undergone routine episiotomy whereas 29 women (47.5%) had gone through restrictive episiotomy. Right mediolateral episiotomies were performed in all cases. The rate of anal sphincter tear was 12.5% in the routine episiotomy group versus 13.8% in the restrictive episiotomy group (p = 1.00). Levator ani avulsion was detected in 9.4% of the routine episiotomy group (only on the right side) and in 10.3% of the restrictive episiotomy group (p = 1.00). No bilateral levator avulsion was detected in either of the groups. There were no statistical differences in the distances of the bladder neck descent, cystocele descent, uterine descent, rectocele descent, and the ballooning of the genital hiatus area between the groups. In our pilot study, there was no reduction of the rate of levator ani avulsion in women with restrictive episiotomy compared with routine episiotomy. There were no differences in pelvic floor ultrasound parameters between the two groups.

A Systematic Review of the Use of Routine Versus Selective Episiotomy for Vaginal Birth.

Episiotomy is a common obstetric surgical procedure involving an incision to enlarge the vaginal opening, facilitating the delivery of the fetus during the second stage of labor. Hence, the current review was conducted to assess the impact of using selective versus routine episiotomy during vaginal birth on birth outcomes. This systematic review used the Joanna Briggs Institute (JBI) methodology for systematic reviews and research syntheses. PubMed, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and SCOPUS were searched for relevant studies. Two reviewers independently screened and extracted data from relevant studies.Four studies met the eligibility criteria and were included in this review. The findings suggest selective episiotomy is associated with better maternal and fetal outcomes than routine episiotomy in certain contexts. However, results varied, indicating the importance of tailoring episiotomy practices to specific patient populations and healthcare settings. To conclude, the review supports the use of selective episiotomy over routine episiotomy during vaginal birth, as it is associated with fewer adverse maternal outcomes.

Obstetric perineal trauma

Obstetric perineal trauma is a common pathology that complicates up to 90% of vaginal deliveries. The true incidence of injuries (and their severity) is usually underestimated and higher than reported. Obstetric perineal injuries have a serious impact on a woman’s well-being and have medical, emotional, social and psychological aspects. Their negative consequences can persist for many years after childbirth and have a potentially devastating impact on a woman’s quality of life, lead to severe morbidity due to persistent pain, pelvic floor dysfunction, urinary and faecal incontinence, sexual problems, high risk of re-injury during future childbirth, etc. The article presents an overview of existing national guidelines for the prevention and treatment of perineal injuries. The data on the frequency and risk factors of perineal tears are systematized, and a modern classification is presented. Particular attention is paid to obstetric anal sphincter injuries (OASIS) for a better understanding of this pathology by partitional doctors. Training and awareness of obstetricians about OASIS should help to identify patients at risk, more accurately diagnose and choose the right tactics. The article also describes the main preventive interventions during pregnancy and childbirth, discussing the advantages and disadvantages of each. Given the high frequency of episiotomy for the prevention of OASIS, the advantages and disadvantages of various options, as well as the correct 45-60˚ technique, are presented. The emphasis is placed on the fact that it is necessary to perform selective episiotomy rather than routine episiotomy in the presence of clear indications according to the national standard. Reducing the frequency of episiotomies should lead to a decreased number of iatrogenic perineal injuries. The general principles of surgical treatment of perineal injuries, various suturing techniques, suture material characteristics, postoperative management of patients and counselling for future births are also presented.The use of these recommendations by obstetricians will be useful for their practice and will help improve the quality of medical care.

Role of Obstetric Violence and Patient Choice: Factors Associated With Episiotomy.

In the United States, 1 in 6 women reports obstetric violence in the form of physical and verbal abuse, coercion, and lack of informed consent. Despite recommendations against routine episiotomy, its use in the United States remains notable and varies considerably. This study aimed to analyze the various forms of obstetric violence associated with undergoing an episiotomy and having a choice in undergoing an episiotomy. Data from the cross-sectional Listening to Mothers in California survey were analyzed using weighted sample. Logistic regression models were conducted to compute adjusted odds ratios (aORs) and 95% CIs for undergoing episiotomy and having a choice in it. Overall, 21% of the respondents reported undergoing an episiotomy, and 75% of them reported not having a choice in undergoing this procedure. After adjusting for covariates, feeling pressured to induce labor (aOR, 1.31; 95% CI, 1.28-1.35) and to use an epidural analgesia (aOR, 1.82; 95% CI, 1.77-1.88) increased the odds of undergoing an episiotomy. Having a midwife during childbirth significantly reduced the odds of an episiotomy. Respondents who indicated being handled roughly by health care providers were 95% less likely to have a choice in receiving an episiotomy (aOR, 0.05; 95% CI, 0.04-0.06). This is the first study to examine other forms of obstetric violence as correlates of episiotomy and having a choice in it. Standardized institutional measures against obstetric violence, patients' ability to make autonomous decisions through informed consent, and engaging midwives could decrease medically unnecessary labor procedures and associated complications.

Health-promoting lifestyle in mothers with vaginal childbirth and cesarean section in the postpartum period

BackgroundIn the postpartum period, there are numerous changes in the physical and psychological dimensions of women, which reduce the quality of life of women. The aim of this study was to compare the health-promoting lifestyle of mothers with vaginal delivery and cesarean delivery in the postpartum period.MethodsThis cross-sectional study was conducted on 77 pregnant women who had delivered vaginal or by cesarean section at Shohadaye Behshahr Hospital and were selected based on inclusion criteria. If the women were willing to participate in the study, a demographic questionnaire was completed, and the telephone numbers of the subjects were recorded so that the Porsline health-promoting lifestyle questionnaire could be sent to them. Data were analyzed with SPSS 22 using the T test, chi-square test and Repeated Measure ANOVA.ResultsThere was no difference in the average score of health-promoting lifestyle and its dimensions between the two groups of vaginal delivery and cesarean section at two and six weeks after delivery. However, in both groups, the total score of health-promoting lifestyle decreased significantly over time (P < 0.001).ConclusionsThere was no difference in health-promoting lifestyle between mothers with vaginal and mothers with cesarean delivery at two weeks and six weeks after delivery. This requires more attention from policy makers to make vaginal childbirth more convenient, and by reducing complications after vaginal childbirth, they can improve women’s healthy lifestyles and, in turn, families. Also, it seems that the other variables apart from the method of delivery should be considered, and it is necessary to distinguish these variables such as routine episiotomy in order to prevent the decrease in the level of health-promoting behaviors among women during puerperium period.

Episiotomia: a caracterização do estado de anomia dos direitos sexuais e humanos no momento do parto

The objective of this article was to analyze the routine episiotomy as a form of institutional and sexual obstetric violence based on existing normative dispositions and the sexual culture of the society in order to ascertain a context of anomie and the tortuous character of the procedure. The method of inductive approach in the configuration of the episiotomy as an inhuman and degrading treatment was used, equating it to torture. The procedure method is the monographic one with the use of bibliographical and legislative research. As results, it was verified that the episiotomy is located in a context of anomia, since there are normative instruments that discourage its practice because it is a lesion in the perineum that violates sexual and human rights, and its unrestricted realization constitutes a violation of the Code of Medical Ethics. It is also contemplated that the episiotomy is a kind of torture, because it is subsumed in a context of mistreatment, offense to the corporal integrity, violation of the free disposition of the body, of the right to the information for the making of autonomous and informed decisions and to consent without coercion, in addition to sexual and human rights, ending discriminatory, demeaning and disrespectful treatment of women's sexual and human rights.

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.

Homage to Dr. Murray Enkin and the complexity of evidence-based medicine.

Homage to Dr. Murray Enkin and the complexity of evidence-based medicine.

Episiotomy in Modern Obstetrics OR Episiotomy: It's Time to Stop Cutting!

Episiotomy consists of incising the perineum to widen the birth canal. It was historically introduced into medical practice in the 18th century. The purpose of the episiotomy would be to reduce the probability of severe perineal lacerations, while the association with the forceps would minimize the risk of fetal trauma and hypoxia, which was accepted for a long time as an indisputable truth. The use of episiotomy spread enormously after the recommendations of famous obstetricians and began to be used on a larger scale in several countries since the 20th century, although there was no reliable scientific evidence of its effectiveness and safety. In the last decades well-conducted clinical studies on the subject were published and the routine use of episiotomy was questioned. Despite of methodological limitations, the first studies contributed to reduce its practice, including the important participation of women's movements and active childbirth campaigns arguing about the episiotomy use. Current evidence shows that routine episiotomy is not supported in clinical practice and a recent World Health Organization (WHO) guideline strongly recommends against it. However, a lack of knowledge remains as the role of episiotomy in obstetric emergencies and, considering the present evidence, what would be the real benefits for performing an episiotomy. This review aims to show the current state of the art running through the historical background of episiotomy and techniques, analyzing its use worldwide in obstetric practice and discussing the published studies concerning the necessity, the effectiveness, and the consequences of the procedure. Ultimately, regarding the accumulated evidence shown, the authors express their conclusions about the use of episiotomy in obstetric modern practice and the possible strategies to reduce its rates.

Раціоналізація підходів до ведення епізіотомної рани

Episiotomy is a surgical manipulation that has become one of the most frequently performed surgical procedures in the world. According to World Health Organization recommendations, the overall frequency of episiotomy use should not exceed 10% of vaginal deliveries. However, in some developed countries, there are significant discrepancies in clinical experience with the use of episiotomies, with rates ranging from 5.2% (USA), 9.7% (Sweden) to 100% (Taiwan), including both primiparous and multiparous women. Purpose - to evaluate global data on the appropriateness of routine episiotomy use, the importance of studying wound healing and methods of managing episiotomy wounds. Considering that episiotomy continues to be used by physicians worldwide, there is a need for more detailed assessment of the appropriateness of performing episiotomy, wound healing, search for new approaches to managing episiotomy wounds, and prevention of complications. Conclusions. The results of numerous studies indicate the importance of more detailed study of the issue of episiotomy wound repair and methods of treatment during the postpartum period. However, given the significant achievements reflected in publications on the study of episiotomy management, there is a need to search for an optimal approach to management, predicting success and risk factors affecting episiotomy wound healing. No conflict of interests was declared by the authors.

Use of Prophylactic Antibiotics in Third and Fourth Degree of Perineal Rupture

Numerous studies have demonstrated how routine episiotomies can cause additional problems like poor postpartum sexual function, ongoing perineal pain, and increased anal sphincter damage resulting in flatus or fecal incontinence. To combat the high frequency of maternal labor morbidity, antibiotic prophylaxis is recognized as a method of intervention that can be applied. . On the other hand, several studies seem to support the use of preventive antibiotics in situations of severe perineal rupture. It is not advised to use antibiotics excessively due to the rising prevalence of their use, which increases the danger of antibiotic resistance. As a result, following a serious perineal tear, the use of prophylactic antibiotics is crucial to preventing infection and determining whether a side effect is present in the mother or infant. Therefore it is necessary to assess the effectiveness of antibiotic prophylaxis to reduce maternal morbidity and side effects of third and fourth-degree perineal rupture during vaginal delivery.

Restrictive v/s Routine episiotomy in Primigravida

Introduction: Episiotomy is the surgical enlargement of the vaginal orifice by an incision on the perineum during the last part of the second stage of labour or delivery. Episiotomy is the most common surgical procedure experienced by women. In near past there were many studies pointed out its disadvantages like more post-delivery pain, wound complications and dyspareunia. So, this study was done to compare use of restrictive episiotomy and routine episiotomy in primigravidae undergoing vaginal birth. Aims and objectives: To assess the effects of restrictive use of episiotomy in comparison with routine episiotomy in primigravida during vaginal birth in terms of - (1) No. of episiotomies can be avoided (2) Perineal tear (3) Blood loss (4) Hematoma &amp; Healing complications (5) Faecal &amp; urinary incontinence (6) Dyspareunia. Material and methods: This study was descriptive analytic study conducted in the Department of Obstetrics and Gynecology, Surat municipal institute of medical education and research (SMIMER), Surat from January 2017 to June 2019 with sample size of 148 patients. Results: This study included total 148 patients, where 74 were selected randomly in each group. In Restrictive Episiotomy group, out of 74 patients, Episiotomy was required in 18 (24.32%) patients. Thus, Episiotomy was avoided in 56 (75.68%) patients. Mean duration of second stage of labour in Routine Episiotomy group was 31.88 ± 5.37min and in Restrictive Episiotomy group it was 32.35 ± 3.73min, which was suggestive of no statistically significant difference. (p value = 0.5375). Total 4.05% patients in Routine group and 13.51% patients in Restrictive group suffered from anterior vaginal tear which was statistically significant (p value = 0.021). There were 2 cases (18%) of 2nd degree perineal tear in routine episiotomy group which were 8(40%) in restrictive episiotomy group. The difference was statistically assessed by Chi-square and found to be significant (p value=0.2399). Not a single case of 3rd &amp; 4th degree perineal tear in either group. In Routine Episiotomy group, suturing was done in 100% patients. While restricted episiotomy group only 44.59% needed suturing which was statistically significant (p value:&lt;0.0001). Average blood loss in Routine group was 341.89 ± 49.33ml and in Restrictive group was 301.01 ± 52.41ml. So, there was significantly higher blood loss in Routine Episiotomy group. (p value= 0.000002). Complications rate in the form of episiotomy wound gap and hematoma was higher in routine group in 5.41% patients as compared to 1.35% patients in Restrictive group. Postpartum perineal pain at 1 week (14 v/s 5) and 2 weeks (5 v/s 1) was significantly higher in routine group as compared to the restrictive group. Postpartum perineal pain at 1 week and 2 weeks was significantly higher in routine group as compared to the restrictive group. Conclusion: In conclusion on the basis of our study, the immediate outcomes of routine episiotomy are no better than the restrictive use of episiotomy. Indeed, routine use is harmful to the degree that some proportion of women who would have had lesser injury instead had a surgical incision. The routine use of episiotomy has higher incidence of peripartum blood loss, requirement of suturing, postpartum perineal pain and healing complications. The policy of restrictive use of episiotomy is not associated with any third and fourth degree perineal tear or adverse neonatal outcomes.

Examining the Association Between Episiotomy and Severe Perineal Tears in a Tertiary Care Center Implementing a Restrictive Episiotomy Policy.

Background Perineal lacerations are feared complications of vaginal delivery, especially the severe types (third- and fourth-degree tears). World Health Organization (WHO) recommended restrictive episiotomy practice after alarming literature linked the increase in severe tears with routine episiotomy. Therefore, this study aimed to measure the association between episiotomy and the incidence of third- and fourth-degree perineal tears and infections in women who underwent episiotomy versus those who did not at a tertiary care center implementing the restrictive episiotomy policy in Jeddah, Saudi Arabia. Methods This retrospective cohort study was conducted in the Department of Obstetrics and Gynecology at King Abdulaziz Medical City (KAMC), Western Region, between May 2016 and May 2018, targeting all pregnant women who underwent normal spontaneous vaginal delivery. The nonprobability convenient sampling technique was used for women who underwent episiotomy. Women without episiotomy (control group)were randomly selected in a 1:1 ratio. The prevalence (incidence) of episiotomy and its association with severe perineal tears were measured. Statistical data were analyzed using SPSS version 27 (IBM Corp., Armonk, NY). A p-value of less than 0.05 was considered significant. Result A total of 7436 deliveries were recorded. At KAMC, episiotomy had a prevalence of 10% and was more common in primipara. The incidence of third-degree tears was 3.3% in the episiotomy group and 0.8% in the control group (odds ratio, 4.1; p = 0.03). None had fourth-degree tears. Furthermore, the infection rate was not significantly different between the two groups (0.1% vs. 0.1%). Using Firth's logistic regression model, primipara emerged as an independent significant risk factor (OR, 3.5 [1.1-11.2]; p = 0.035)while the trend toward increased risk for tear development in the episiotomy group became statistically insignificant (OR, 2.3 [0.7-8.0]; p = 0.19). A post hoc examination to observe the association between episiotomy exposure and BMI using a stepwise logistic regression model showed that parity and age were independent risk factors for episiotomy, with OR values of 2.2 (1.6-3.2) and 0.9 (0.88-0.94), respectively (p < 0.001). The BMI became insignificant, with an OR of 1.0 (0.7-1.4) (p = 0.96). Conclusion The development of severe perineal tears in acenter with a restrictive episiotomy policy is rare. Parity has emerged as an independent risk factor for severe perineal tears.Prospective multicenter research with a larger sample size is recommended to validate this study's findings further and investigate other obstetric measures to reduce severe tears in primi mothers.

The Safety of Selective Episiotomy Compared to Routine Episiotomy During Vaginal Birth in Primigravida in Cairo University Hospitals

The Safety of Selective Episiotomy Compared to Routine Episiotomy During Vaginal Birth in Primigravida in Cairo University Hospitals

Comparison between No and Routine Mediolateral Episiotomy during Delivery in Primigravidae, Regarding Maternal and Neonatal Outcome

Comparison between No and Routine Mediolateral Episiotomy during Delivery in Primigravidae, Regarding Maternal and Neonatal Outcome

Is there still an indication for episiotomy? Results from a French national database analysis.

To assess the link between mediolateral episiotomy and the occurrence of obstetrical anal sphincter injury (OASIS). Data were collected from the national database (PMSI; Programme de Médicalisation des Systèmes d'Information). Women between 18 and 50 years old, undergoing a vaginal delivery in France in 2018 were included. The main outcome was factors associated with a higher adjusted OASIS rate after a vaginal delivery. Of 623 003 women with a vaginal delivery, 239 949 were primiparous (38.5%), 62 310 experienced mediolateral episiotomy (10.0%) and 7077 had a third- or fourth-degree perineal tear (1.14%). Risk factors for OASIS were primiparity (adjusted odds ratio [OR] 2.97), shoulder dystocia (aOR 2.57), instrumental delivery (aOR 2.81), gestational diabetes (aOR 1.20), and post-term delivery (aOR 1.53). Mediolateral episiotomy increased the occurrence of OASIS for women without an instrumental delivery, either for parous (OR 1.32, 95% confidence interval [CI] 1.07-1.62) or primiparous (OR 1.26, 95% CI 1.13-1.39) women. In contrast, episiotomy among primiparous women with episiotomy and a vacuum or forceps delivery significantly decreased the risk for OASIS (OR 0.62, 95% CI 0.56-0.67). The practice of routine episiotomy should be discouraged. Selective mediolateral episiotomy should be considered with extreme caution and mainly for primiparous women during instrumental vaginal delivery. Further randomized trial may confirm such results.

Determinants of Pelvic Floor Disorders among Women Visiting the Gynecology Outpatient Department in Wolkite University Specialized Center, Wolkite, Ethiopia.

Background Pelvic floor disorders encompass a broad range of interrelated clinical conditions. Pelvic floor disorders are a common public health concern that affects the lives of millions of adult females. This disorder is expected to be more widespread and probably more severe among women in low-income countries. However, there is limited knowledge about pelvic floor disorders and their determinants among women in Ethiopia. Objective The purpose of the study was to assess the determinants of pelvic floor disorders among women who visited the gynecology outpatient service at the Wolkite University Specialized Hospital, Wolkite, Ethiopia, in 2021. Methods A cross-sectional hospital study was conducted on 275 randomly chosen women from June 1 to July 1, 2021. A systematic sampling technique was used when selecting the study subjects. The data were gathered using interviewer administered structured questionnaires. The data collected was entered in version 3.1 of EpiData, and version 23 of Statistical Package for Social Sciences was used for the analysis. The variables with a P-value <0.25 in the bivariate analysis were considered for a subsequently built multivariable model, and factors with P < 0.05 in the final model were statistically significant. The results were presented in an adjusted odds ratio with a 95% confidence interval. Result The prevalence of pelvic floor disorder was reported to be 17.8% with 9.3% of the women experiencing urinary incontinence, 8.9% experiencing pelvic organ prolapse, and 5.9% experiencing anal incontinence. Two hundred thirty-two (85.9%) were currently married, while 110 (40.7%) were housewives. Statistically, a significant association was found between age at first pregnancy (AOR = 5.193; 95% CI = 1.905–14.157), many vaginal deliveries (AOR = 15.858; 95% CI = 5.305–47.400), history of episiotomy (AOR = 7.508 95% CI = 1.556–36.224), and menopause (AOR = 7.665; 95% CI = 2.440–24.078) when analyzed with a multivariate logistic regression model. Conclusion In this study, age at first pregnancy, number of vaginal births, history of episiotomy, and menopause were independently associated with pelvic floor disorder. Therefore, educating women about the year of their first pregnancy, promoting family planning, and advice on the prevention of routine episiotomy by a health professional is recommended.

Selective versus routine use of episiotomy for vaginal births in Shanghai hospitals, China: a comparison of policies

BackgroundTo assess the effects of policy of selective versus routine episiotomy on mother and baby for women delivering vaginally in Shanghai and whether the hospital type has any effect on the outcomes.MethodThis was a multi-center retrospective cohort study in Shanghai between March 2015 and May 2017. The study population were vaginal births with selective or routine episiotomy (n = 5478) in 20 secondary or tertiary hospitals. Main Outcome Measure was the incidence of severe perineal lacerations. The adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated by logistic regression and presented as the effect sizes. All models were stratified by the utilization of level (secondary and tertiary) and type (general and Obstetric) of hospital.ResultsThe primary outcome was not significantly different between vaginal births with routine and selective episiotomy. Patients with selective episiotomy had a lower risk of postpartum hemorrhage, and newborns in the selective episiotomy group had a lower risk of shoulder dystocia and Neonatal Ward compared to those with routine episiotomy. Newborns in selective episiotomy group had a lower risk of birth injury in tertiary hospital. However, newborns in selective episiotomy group had a higher risk of birth injury in general hospitals.ConclusionSelective episiotomy is safe and can be recommended over routine episiotomy in obstetric and tertiary hospital settings in China.

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.