A multicenter cross‐sectional study of episiotomy practice in Romania

Abstract

Rationale, aims, and objectives The aim of this study was to focus attention on episiotomy practice in Romanian maternity units in order to identify factors associated with the very high rate of the procedure in Romania and to consider strategies to reduce it. Methods In this clustered cross‐sectional study, a total of 11 863 patients were recorded in eight Romanian maternity units to assess the prevalence of episiotomy. A random effects Poisson model was used to estimate the prevalence rate in univariate and multivariate models. Results Among the 11 863 patients included for analysis, 8475 (71.4%) had an episiotomy. The prevalence of episiotomy was 92.7% for the first vaginal birth, 73.2% for the second vaginal birth, and 35% for the third vaginal birth. The overall rate of suturing was higher than the episiotomy rate for all patients (total rate 79.2%). The likelihood of exiting the maternity ward with an intact perineum after the first vaginal birth was less than 5% at the first vaginal birth. Conclusions In conclusion, routine episiotomy is the norm in Romanian maternity units, with episiotomy rates among the highest in Europe. Episiotomy use is mainly driven by local professional norms, experiences, previous training, and practitioners' decisions rather than evidence, guidelines, or variations in patient needs at the time of vaginal birth.

Criteria for Cesarean Section-an Imperative and Emergent Necessity in Romanian Obstetrics

“…Although Romanian obstetricians are obviously fierce opponents of the rules [1][2][3][4], we succeeded in implementing in 2018 (without any national or local level legislative norm that would oblige us to do so) Robson's classification in Obstetrics and Gynecology Clinic of the Emergency Clinical Hospital Sf. Pantelimon in Bucharest.…”

“…It is no longer a novelty that the cesarean section rate in Romania is among the top three in Europe and that it is among the top ranked in the world [1][2][3][4][5][6][7]. Some of the most recent statistical dates offered by World Health Organization (WHO) for Romania contained a caesarean rate of approximately 36% [1][2][3][4].…”

“…As in many other parts of the globe, the causes of this high cesarean rate are not fully elucidated, but they appear to be the result of a variety of factors such as on demand cesarean and defensive cesarean, attributes of an obstetric medicine and medicine in an accelerated expansion after a long period of prohibitions [1][2][3][4].…”

“…Another well-known fact is that countries do not constantly report data and that global reporting is not only discontinuous but also profoundly flawed by the absence of uniform reporting criteria to the WHO [1][2][3][4]. This makes it almost impossible to accurately and scientifically determine the causes and consequences of this variable percent of caesarean section [1], which is why there was more than a need for a language uniformization formula used by experts and professionals in the field, as well as uniformity of reporting rules.…”

Iodoform (triiodomethane)- An Old, but Still Extremely Efficient Antiseptic

“…The number of surgical interventions of all types has steadily increased worldwide, sometimes even alarming (e.g. caesarean section) [1][2][3][4][5].…”