Factors associated with episiotomy practice in Bukavu, Democratic Republic of the Congo

Abstract

Background: The primary objective of the present study is to determine the episiotomy rate and factors associated with practice of episiotomy at the maternities in Bukavu town, South-Kivu, DRC.Methods: A case-control study was carried out the women who underwent the episiotomy (case) and those which did not undergo episiotomy (control) over one 12 months period between January to December 2015. A total of 1878 women had a vaginal delivery at a rate of one case for one control (939 cases and 939 controls) were included. Their medical files were exploited. The factors associated with episiotomy were performed by logistic regression.Results: The rate of episiotomy was 20.4%. It was found that after the logistic regression, the Primiparity (OR = 4,5;95% CI:2,31-4,49), the existence of a foetal distress (OR = 4,2;IC to 95% CI :2,36-5,29), the antecedent of episiotomy (OR = 3,9;95% CI:2,83-7,07), private character of maternity (OR= 3,3; 95% CI :2,12-6,30) and the fact that the childbirth was directed by a doctor (OR = 2,3; 95% CI :1,85-5,08) were strongly associated with the practice of the episiotomy in our medium of study.Conclusions: This study showed UA-S/D ratio and UA-RI>2SD are significant predictors of perinatal deaths and immediate neonatal resuscitation in preeclampsia. Acute fetal distress in labour or neonatal nursery admission could not be predicted.

Prevalence of episiotomy practice and factors associated with it in Ethiopia, systematic review and meta-analysis

“…Whereas, this finding was almost two to three times higher than the study conducted in the Democratic Republic of Congo 20.4%, 40 Brazil 29.1%, 41 Vietnam 29.9%, 42 Burkina Faso 22%, 43 and Nigeria 9.3%. 44 The reason for this might be that in those countries the practice of routine episiotomy was restricted by national guidelines and they were valuing recommendations from WHO.…”

“…There are some studies from different countries that support this finding; Iran, 38 Colombia, 50 Vietnam, 42 and Congo. 40 This might be because women with first pregnancy have tight perineum which increases the risk of perineal injury and the obstetrics care providers might have a belief of episiotomy necessity for primigravid women even without clear indications.…”

Episiotomy Practice and Its Associated Factors in Africa: A Systematic Review and Meta-Analysis

“…Eighteen primary studies employed an analytical cross-sectional study design, while the remaining three studies employed a descriptive cross-sectional study design. Regarding the settings in which the studies were conducted eight studies were conducted in Ethiopia ( 45 , 46 , 54 , 57 , 61 , 64 , 66 ), eight in Nigeria ( 40 – 42 , 58 , 63 , 65 , 82 ), and the remainder of the studies were conducted in the Democratic Republic of the Congo (DRC) ( 69 ), Zimbabwe ( 83 ), Uganda ( 55 ), Ghana ( 84 ), and Burkina Faso ( 85 ). The majority of the studies, 16 (76.2%), were reported from Eastern and Western African countries.…”

“…According to Macleod et al ( 50 ), Koskas et al ( 51 ), Giannella et al ( 52 ), Cromi et al ( 48 ), Beyene et al ( 53 ), Tobiaw Tefera et al ( 54 ), Teshome et al ( 46 ), and Pebolo et al ( 55 ) episiotomy was significantly associated with a prolonged second stage of labor. Furthermore, macrosomia ( 42 , 51 , 53 , 54 , 56 – 58 ), advanced gestational age ( 49 , 59 , 60 ), breech presentation ( 50 , 51 , 57 , 60 – 62 ), primiparity ( 40 – 42 , 45 , 46 , 53 , 56 – 58 , 61 , 63 – 65 ), oxytocin use ( 45 , 53 , 59 , 62 , 66 , 67 ), meconium-stained amniotic fluid ( 49 , 50 ), reduced apgar score ( 67 ), assisted breech vaginal delivery or vaginal operative delivery (forceps) ( 41 , 42 , 53 , 54 , 56 , 58 , 61 , 63 , 66 ), analgesia ( 49 , 67 , 68 ), non-reassuring fetal heart rate pattern ( 68 ), persistent occipito posterior position ( 41 ), post-term pregnancy ( 45 ), fetal distress ( 47 , 69 ), perineal tear ( 66 ), private character of the mother ( 41 ), a history of gestational hypertension ( 45 ), birth spacing <2 years ( 66 ), vaginal birth after cesarean section ( …”

Episiotomy practice and associated factors among mothers who gave birth at public health facilities in Metema district, northwest Ethiopia

“…Findings in Israel, Kurdistan region, Republic of Congo, Zimbabwe and in our country at Mizan Aman general Hospital, at Akaki Kality and at Saint Paul’s hospital Millennium Medical College showed that perineal laceration (tear), duration of second stage of labour more than 90 min, ANC follow up history, time of delivery, previous history of episiotomy and known medical diseases were significant predictors for episiotomy practice [ 43 , 44 , 46 , 47 , 49 , 52 ]. Studies in Northeast of Iran, Brazil, Republic of Congo, Israel, Kurdistan region, Zimbabwe and in our country at Mizan Aman general Hospital, at Akaki Kality, at Saint Paul’s hospital Millennium Medical College, at Axum town public health institution and at Jima teaching Hospital identified that birth weight of 4 kg and above, gestational age, presence of meconium, sex the neonate, breech and shoulder presentation and condition of fetal heart rate were significant factors for episiotomy practice [ 33 , 37 – 39 , 41 , 43 – 55 ].…”