Factors related to episiotomy practice: an evidence-based medicine systematic review

Clesse, Christophe; Lighezzolo-Alnot, Joëlle; Lavergne, Sylvie De; Hamlin, Sandrine; Scheffler, Michèle

doi:10.1080/01443615.2019.1581741

Cited by 17 publications

(26 citation statements)

References 70 publications

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“…Finally, the study found that the chance of episiotomy occurring was higher in private institutions. This result corroborates data from the 2019 systematic review, which shows that hospital financing may be a risk factor for the performance of this surgical incision (18) . In general, women treated in public hospitals have more access to good practices in childbirth and birth care, such as non-pharmacological methods of pain relief, free choice of positions during childbirth, and a greater probability of moving, reducing the chance of undergoing episiotomy.…”

Section: Resultssupporting

confidence: 89%

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Factors associated with the performance of episiotomy

et al. 2020

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Objective: To analyze the factors associated with the performance of episiotomy. Methods: Cross-sectional study, developed with data from the research “Born in Belo Horizonte: Labor and birth survey, “conducted with 577 women who had their children via vaginal birth. In order to verify the magnitude of the association between episiotomy and its possible determinants, logistic regression models were constructed to estimate the odds ratio. Results: Episiotomy was performed in 26.34% of women, and 59.21% knew they had been subjected to it. We observed that younger women, primiparous women, women assisted by a professional other than the obstetric nurse and women who had their babies in a private hospital have an increased chance of being submitted to this procedure. Conclusion: Considering the rates of episiotomy, this study highlights the need for the absolute contraindication to indiscriminate performing it.

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Section: Resultssupporting

confidence: 89%

“…The results of this study showed that younger women and primiparous women were more likely to being submitted to an episiotomy. A systematic review of 2019 confirms these findings (18) . This procedure's performance in primiparous women is associated with higher chances of obstetric lesions of the anal sphincter (19) .…”

Section: Resultsmentioning

confidence: 75%

Factors associated with the performance of episiotomy

et al. 2020

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“…Individual and clinical factors related to mothers; individual and clinical factors related to the newborn; as well as the socio-demographic profiles of the parturient in Africa and other countries influence episiotomy practice ( 36 ). In studies conducted in Brazil ( 37 , 38 ), Nigeria ( 39 – 42 ),Turkey ( 43 ), the United States ( 44 ), and Ethiopia ( 45 , 46 ), the odds of episiotomy practice were positively correlated with younger age at delivery.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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BackgroundEpisiotomy, a surgical procedure that enlarges the vaginal opening during childbirth, was common practice until the early 2000s. Other sources, including the World Health Organization (WHO), advocate for the selective use of episiotomy. Episiotomy rates, on the other hand, have remained high in developing countries, while declining in developed countries. As a result, the current study sought to determine the overall prevalence of episiotomy in Africa as well as the risk factors associated with its practice.MethodsArticles were searched in international electronic databases. A standardized Microsoft Excel spreadsheet and STATA software version 14 were used for data extraction and analysis, respectively. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was used to write this report. A random-effects meta-analysis model was used to determine the pooled prevalence of episiotomy. A heterogeneity test was conducted using I-Squared (I2) statistics. Egger's test and funnel plots were conducted to detect publication bias. Subgroup analysis was also conducted. Association was expressed through a pooled odds ratio (OR) with a 95% Confidence Interval (CI).ResultA total of 21 studies with 40,831 participants were included in the systematic review and meta-analysis. The pooled prevalence of episiotomy practice was 41.7% [95% CI (36.0–47.4), I2 = 99.3%, P < 0.001). Primiparity [OR: 6.796 (95% CI (4.862–9.498)), P < 0.001, I2: 95.1%], medical doctors- assisted delivery [OR: 3.675 (95% CI (2.034–6.640)), P < 0.001, I2: 72.6%], prolonged second stage of labor [OR: 5.539 (95% CI (4.252–7.199)), P < 0.001, I2: 0.0%], using oxytocin [OR: 4.207 (95% CI (3.100–5.709)), P < 0.001, I2: 0.0%], instrument -assisted vaginal delivery [OR: 5.578 (95% CI (4.285–7.260)), P < 0.001, I2: 65.1%], and macrosomia [OR: 5.32 (95% CI (2.738–10.339)), P < 0.001, I2: 95.1%] were factors associated with episiotomy practice.ConclusionIn this review, the prevalence of episiotomy among African parturients was high. A selective episiotomy practice should be implemented to reduce the high episiotomy rates.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021293382, identifier: CRD42021293382.

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“…The results of our own research have shown that the history of a single cesarean section significantly increases the risk of an episiotomy. In the already cited study by Clesse et al (2019), they also noted that the identification of an earlier cesarean section in the mother poses a risk of an episiotomy [ 28 ] Charitou et al (2019) and Carvalho et al (2010) showed that an episiotomy was more common in cases with VBAC [ 29 , 30 ]. On the other hand, Braga et al (2014) found no correlation between an episiotomy and a history of cesarean section [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Episiotomy for Medical Indications during Vaginal Birth—Retrospective Analysis of Risk Factors Determining the Performance of This Procedure

Bączek

Rychlewicz²,

Sys

et al. 2022

JCM

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The WHO (World Health Organization) recommends that the percentage of perineal incisions should not exceed 10%, indicating that this is a good goal to achieve, despite the fact that it is still a frequently used medical intervention in Poland. The risk factors for perineal incision that have been analyzed so far in the literature allow, among others, to limit the frequency of performing this procedure. Are they still valid? Have there been new risk factors that we should take into account? We have conducted this study to find the risk factors for performing perineal incision that would reduce the frequency of this procedure. The aim of the study was to check whether the risk factors that were analyzed in the literature are still valid, to find new risk factors for perineal incisions and to compare them among Polish women. This was a single-center retrospective case-control study. The electronic patient records of Saint Sophia’s Hospital in Warsaw, Poland, a tertiary hospital was used to create an anonymous retrospective database of all deliveries from 2015 to 2020. The study included the analysis of two groups, the study group of patients who had had an episiotomy, and the control group-patients without an episiotomy in cases where an episiotomy was indicated. A logistic regression model was developed to assess the risk factors for perineal laceration. Independent risk factors for episiotomy in labor include oxytocin use in the second stage of labor (OR (Odds Ratio) = 6.00; 95% CI (Confidence Interval): 4.76–7.58), the supply of oxytocin in the first and the second stage of labor (OR = 3.18; 95% CI: 2.90–3.49), oxytocin use in the first stage of labor (OR = 2.72; 95% CI: 2.52–3.51), state after cesarean section (OR = 2.97; 95% CI: 2.52–3.51), epidural anesthesia use (OR = 1.77; 95% CI: 1.62–1.93), male gender (OR = 1.10; 95% CI: 1.02–1.19), and prolonged second stage of labor (OR = 1.01; 95% CI: 1.01–1.01). A protective factor against the use of an episiotomy was delivery in the Birth Centre (OR = 0.43; 95% CI: 0.37–0.51) and mulitpara (OR = 0.31; 95% CI: 0.27–0.35). To reduce the frequency of an episiotomy, it is necessary consider the risk factors of performing this procedure in everyday practice, e.g., limiting the use of oxytocin or promoting alternative places of delivery.

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Factors related to episiotomy practice: an evidence-based medicine systematic review

Cited by 17 publications

References 70 publications

Factors associated with the performance of episiotomy

Factors associated with the performance of episiotomy

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

Episiotomy for Medical Indications during Vaginal Birth—Retrospective Analysis of Risk Factors Determining the Performance of This Procedure

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