Episiotomy practice in six Palestinian hospitals: a population-based cohort study among singleton vaginal births

Abstract

ObjectiveTo explore the rates, characteristics and indications for episiotomy among women delivering vaginally for the first time, as well as parous women.Study designA prospective, population-based birth cohort study.SettingObstetric departments in six Palestinian government hospitals.ParticipantsAll women with singleton vaginal births (n=29 165) from 1 March 2015 until 1 March 2016.MethodsAll women were divided into two groups: first vaginal birth group (n=9108), including primiparous women and women with their first vaginal birth after one caesarean section, and the parous group (n=20 057). Each group was analysed separately. Data were presented as numbers and percentages or range. Differences in rates were assessed by the p values of χ2 test, or Fisher’s exact test if there are cell counts less than 5.Main outcome measuresEpisiotomy rates and indications among women of singleton births.ResultsThe overall episiotomy rate was 28.7%: 78.8% for women with first vaginal birth (range 56.6%–86.0%) and 5.9% for parous women (range 1.0%–9.5%). The most common indications for episiotomy were ‘primiparity’ in the first vaginal birth group (69.9%) and ‘protecting the perineum’ in the parous group (59.5%). The least common indications were prolonged second stage (1.5%) and fetal distress (6.9%), respectively.ConclusionIn Palestine, the majority of women who delivered vaginally for the first time had an episiotomy. Education of birth attendants, clinical audits, educational interventions and adherence to the updated guidelines may help to decrease the routine overuse of episiotomy.

A novel classification for evaluating episiotomy practices: application to the Burgundy perinatal network

“…The combination of such characteristics is of major importance to accurately analyze practices because the episiotomy rates varied broadly: multiparous women at term with cephalic presentation and without instrumental delivery (Group 3) had the lowest rate of episiotomy, while nulliparous women at term with cephalic presentation and with instrumental delivery (Group 2) had the highest rate. Even if the other groups [5–7], and accounted for only 6% of all episiotomies, our results highlight a significant rate in instances of prematurity, breech birth and multiple pregnancy, which are frequently omitted from randomized trials or cohort studies [7, 14, 18, 22, 39, 40].…”

“…Previous studies [14, 19–22] have limited their analyses to overall episiotomy rates or in case of instrumental delivery [37, 38], but no classification has been used so far. The first 4 groups of our classification combine four parameters: parity, term, presentation and mode of delivery.…”

“…A systematic review comparing the different type of classifications used for caesarean section [53] showed that classifications based on women’s characteristics were the most appropriate. In addition, studies dealing with episiotomy indications disclosed that these indications are subjective, not consistent with international practice guidelines [12, 13, 54], variable by country [14, 22], and dependent on the type of obstetrical staff involved [55]. They also reported that many of the indications reported by healthcare professionals are not congruent with international clinical guidelines [54].…”

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

“…9 Another study also suggested that episiotomy is used only if there was an indistinct indication of imminent tearing. 7 There is wide variation in the rates of episiotomy all over the world, from developed countries such as Denmark (4%), 10 Sweden (9.7%), the UK (12%-15%) and the USA (11.6%) 11 12 to developing countries including Saudi Arabia (45%), 13 India (60%), 14 Jordan (67%), Yemen (75.1%), 15 Cambodia (94.5%) 16 and China Taiwan (100%), 12 which are still very high compared with the 10% recommended by the WHO. 6 However, in 2010, the prevalence of third-degree or fourth-degree tears was not significantly different in Denmark (4.1%), Sweden (3.5%), the UK (2.4%-3.2%), the USA (4.9%), India (2.1%) and China (4.9%).…”

Evaluation of Accuracy of Episiotomy Incision in a Governmental Maternity Unit in Palestine: An Observational Study

“…In 2005, Wick et al [ 19 ] published a study comparing routine practices of normal childbirth in eight Palestinian maternity units with the evidence-based guidelines and reported that six of eight units used routine episiotomy for primiparous women. Indeed, a more recent study by Zimmo et al [ 20 ], including six governmental maternity units in Palestine, has shown an overall episiotomy rate of 28.7% and 78.8% among women having their first vaginal birth.…”