Risk factors for mediolateral episiotomy at a tertiary hospital: a cross-sectional study

Abstract

OBJECTIVE:The main aim of this study was to assess the associated factors for selective mediolateral episiotomy at a tertiary, academic hospital. METHODS: A retrospective cohort analysis between 2017 and 2019 was performed. The primary outcome was the prevalence of selective mediolateral episiotomy. Independent variables were maternal, intrapartum, and neonatal characteristics. A significance level of 5% was established, and univariate and multivariate analyses with logistic regression models were performed. RESULTS: From 2,761 vaginal deliveries eligible for inclusion during this period, the prevalence of selective mediolateral episiotomy was 18.7%. Univariate analysis has shown that non-white women were protective factors (OR=0.77 [0.63-0.96]; p=0.02) for episiotomy; primiparity (OR=2.61 [2.12-3.21]; p<0.01), number of vaginal examinations between 6-10 repetitions (OR=3.16 [2.48-4.01]; p<0.01) and 11-20 repetitions (OR=5.40 [3.69-7.90]; p<0.01), longer second stage duration (OR=1.01 [1.00-1.02]; p<0.01), and women with gestational age more than 37 weeks were risk factors. Multivariate analysis reported that second stage duration (AOR=1.01 [1.00-1.03]; p<0.01), primiparity (AOR=2.03 [1.34-3.06]; p<0.01), and number of vaginal examinations between 6-10 repetitions (AOR=2. ]; p<0.01) were remained as risk factors for selective mediolateral episiotomy. CONCLUSION: A higher number of vaginal examinations during labor (over six repetitions), longer duration of second stage labor, and primiparity were risk factors associated with selective mediolateral episiotomy.

Evaluation of perineal wound healing and pain outcomes after low‐angle mediolateral episiotomy in women undergoing vaginal childbirth: A systematic review and meta‐analysis

“…Episiotomy, a strategic surgical incision made in the perineum during the second stage of labour, stands as a pivotal obstetric intervention. Its primary intent is to prevent the occurrence of severe perineal tears, which can lead to long‐term complications such as urinary and faecal incontinence, pain during intercourse and psychological trauma 1,2 . Additionally, episiotomy is employed to facilitate the birthing process, particularly in cases of fetal distress or when there is a need for operative vaginal deliveries, such as with forceps or vacuum assistance.…”

“…Its primary intent is to prevent the occurrence of severe perineal tears, which can lead to long‐term complications such as urinary and faecal incontinence, pain during intercourse and psychological trauma. 1 , 2 Additionally, episiotomy is employed to facilitate the birthing process, particularly in cases of fetal distress or when there is a need for operative vaginal deliveries, such as with forceps or vacuum assistance. The practice of episiotomy, widely adopted in the mid‐20th century, was initially perceived as a preventative measure against more severe spontaneous tears and subsequent pelvic floor disorders.…”