Level of episiotomy practice and its disparity among primiparous and multiparous women in Ethiopia: a systematic review and meta-analysis

Abstract

BackgroundEpisiotomy at the time of vaginal birth is a common lifesaving surgical procedure. In Ethiopia, several studies have been conducted concerning the proportion of episiotomy. However, its prevalence varies across these series of studies. Thus, this systematic review and meta-analysis aimed to estimate the level of episiotomy practice and its disparity among primiparous and multiparous women in Ethiopia.MethodsThis systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. We systematically searched the PubMed/MEDLINE, EMBASE, Google Scholar, and Science Direct databases for studies conducted in Ethiopia focusing on episiotomy. We included all cross-sectional studies published until October 5,2022. Data were analyzed using R version 4.2.1 software. The pooled estimates with 95% confidence intervals (CIs) were presented using forest plots. A random-effects meta-analysis was conducted on extracted crude rates to calculate the national and regional pooled estimates for the country. The I-squared test and Egger's regression test were used to assess heterogeneity and publication bias, respectively.ResultsOur search yielded 390 articles. A total of 13 studies covering five administrative regions and 6,404 women who delivered vaginally were involved. The mean age of the study participants ranged from 22 to 27.7 years. The estimated overall pooled prevalence rate of episiotomy in Ethiopian women was 42.75% (95% CI: 34.97%–50.54%). In the subgroup analysis, the pooled prevalence rate of episiotomy was 61.45% (95% CI: 51.11%–71.80%) among primiparous women. Meanwhile, the pooled estimate appears to be approximately 30.47% (95% CI: 22.08%–38.85%) among multiparous women.ConclusionOur findings concluded that the pooled prevalence rate of episiotomy was higher than the evidence-based WHO recommendations for optimal patient care. Parallel to this, nulliparous women had a higher episiotomy rate than multiparous women. These findings highlight the importance of continued training for labor ward staff, particularly healthcare providers who often perform the majority of deliveries.

Analysis of Maternal Positions during the Dilation and Expulsive Phase and Their Relationship with Perineal Injuries in Eutocic Deliveries Attended by Midwives

“…A multicenter clinical trial conducted in 2019 observed a 10% rate of perineal intactness in multiparous women, emphasizing the need for a restrictive episiotomy approach to childbirth to reduce perineal trauma. These findings were consistent with several studies in which primiparity was identified as one of the main risk factors associated with episiotomy [21][22][23][24][25][26]. In addition, factors such as fetal weight greater than 4000 g and vacuum extraction have been found to be independent risk factors for both second-degree perineal tears and obstetric anal sphincter injury [21].…”

“…In addition, factors such as fetal weight greater than 4000 g and vacuum extraction have been found to be independent risk factors for both second-degree perineal tears and obstetric anal sphincter injury [21]. Other studies have also identified influential factors for the performance of episiotomy in primiparous women, such as maternal age, maternal body mass index, presence of analgesia, duration of the second stage, estimated birth weight, and perineal stress [22][23][24][25][26]. These findings led us to ask what characteristics are determinant for a higher rate of episiotomy in primiparous women and whether these characteristics justify the difference in numbers compared to multiparous women.…”

Frecuencia de la práctica de la episiotomía en una institución en Quito, Ecuador, 2009-2022

“…De manera similar, en dos servicios de maternidad de Río Grande del Sur (Brasil), se reportó una tasa del 51,3 % en un estudio reciente 3 . En Uganda, Pebolo et al 18 reportaron una prevalencia del 73 % (181/249) (IC 95 %: 67-78), mientras que en Etiopía, una revisión sistemática señaló una prevalencia de episiotomía del 42,75 % 19 . En Noruega, datos del hospital universitario de St. Olav's mostraron que aproximadamente el 46,3 % de las mujeres fueron sometidas a episiotomía 20 .…”