Episiotomy practices in France: epidemiology and risk factors in non-operative vaginal deliveries

Abstract

Episiotomy use has decreased due to the lack of evidence on its protective effects from maternal obstetric anal sphincter injuries. Indications for episiotomy vary considerably and there are a great variety of factors associated with its use. The aim of this article is to describe the episiotomy rate in France between 2013 and 2017 and the factors associated with its use in non-operative vaginal deliveries. In this retrospective population-based cohort study, we included vaginal deliveries performed in French hospitals (N = 584) and for which parity was coded. The variable of interest was the rate of episiotomy, particularly for non-operative vaginal deliveries. Trends in the episiotomy rates were studied using the Cochran-Armitage test. Hierarchical logistic regression was used to identify variables associated with episiotomy according to maternal age and parity. Between 2013 and 2017, French episiotomy rates fell from 21.6 to 14.3% for all vaginal deliveries (p < 0.01), and from 15.5 to 9.3% (p < 0.01) for all non-operative vaginal deliveries. Among non-operative vaginal deliveries, epidural analgesia, non-reassuring fetal heart rate, meconium in the amniotic fluid, shoulder dystocia, and newborn weight (≥ 4,000 g) were risk factors for episiotomy, both for nulliparous and multiparous women. On the contrary, prematurity reduced the risk of its use. For nulliparous women, breech presentation was also a risk factor for episiotomy, and for multiparous women, scarred uterus and multiple pregnancies were risk factors. In France, despite a reduction in episiotomy use over the last few years, the factors associated with episiotomy have not changed and are similar to the literature. This suggests that the decrease in episiotomies in France is an overall tendency which is probably related to improved care strategies that have been relayed by hospital teams and perinatal networks.

Impact of SARS‐CoV‐2 infection on risk of prematurity, birthweight and obstetric complications: A multivariate analysis from a nationwide, population‐based retrospective cohort study

“…The main strength of our study is the use of comprehensive nationwide PMSI data. The fact that these national data are used for the allocation of hospital budgets encourages improvement in data quality in terms of coherence, accuracy and exhaustiveness, and justifies its use in several domains including perinatality 74–76 . A previous validation study 77 confirmed the quality and the exhaustiveness of PMSI data, especially for the recording of gestational age.…”

Physical abuse of young children during the COVID-19 pandemic: Alarming increase in the relative frequency of hospitalizations during the lockdown period

“…The main strength of our study is that it is based on comprehensive nationwide PMSI data. The fact that these national data are used for the allocation of hospital budgets encourages improvement in data quality in terms of coherence, accuracy and exhaustiveness and justifies its use in several domains including perinatality and COVID-19 ( Clesse et al, 2020 ; Iacobelli et al, 2017 ; Piroth et al, 2020 ; Quantin et al, 2021 ; Revert et al, 2018 ). It provides data on child physical abuse, a major public health problem which, paradoxically, remains poorly documented ( Jud et al, 2013 ).…”

Obstetrical Soft Tissue Trauma during Spontaneous Vaginal Birth in the Romanian Adolescent Population—Multicentric Comparative Study with Adult Population

“…Fetal macrosomia was featured in our results as a risk factor for group II lacerations among adult mothers, but this finding could not be verified for teenage mothers as well; we interpreted these results as concurrent with the fact that neonates delivered by young women had significantly lower birth weight compared to those delivered by adult mothers. However, in this situation, gestational age must be considered as a potential confounding variable; a recent populational study denoted that prematurity reduced the risk of episiotomy both in teenage mothers and in patients 30 to 39 years of age [ 28 ] but in our country, particularly in preterm deliveries, episiotomy remains a very popular practice [ 29 ].…”

“…In recent years, episiotomy rates underwent a significant reduction worldwide along with a slight increase in perineal tears [ 5 , 28 ]. In a previous European study, Blondel et al identified a significant negative correlation between episiotomies and third- and fourth-degree perineal tears [ 35 ]; our results on the association between these variables show the persistence of an inversely proportional relationship, augmented in the young mothers group, where no severe lacerations were identified but episiotomy reached rates as high as 56%.…”

“…Future Romanian research should assess the clinical implications of enhancing the diagnostic accuracy of algorithms for obstetrical soft tissue trauma since this healthcare system already has a reduced potential of bearing additional financial burdens. The power of example can be seen with the publication of French guidelines for episiotomy, which led to an immediate decline in its practice although the correlated factors did not change; strategies for care improvement in obstetrics departments have managed to succeed in the proper implementation of these protocols [ 28 ].…”