<p>Factors Associated with Episiotomy Practices in Bahirdar City, Ethiopia: A Cross-Sectional Study</p>

Abstract

Background Episiotomy is the surgical enlargement of the vaginal orifice during the last part of the second stage of labor or childbirth by an incision to the perineum. The World Health Organization advises the use of episiotomy on a restricted and selective basis. Indeed, the rate of episiotomy in developed countries is decreasing, but in developing countries, including Ethiopia, it still remains high. Therefore, this study tried to assess the proportion and factors associated with episiotomy among women who gave birth at Felege Hiwot Referral Hospital, Bahir Dar City, North West Ethiopia, 2017. Methods An institution-based cross-sectional study was conducted among 411 mothers from February to April 2017. Data were collected through face-to-face interviews and supported by observation using standard checklist with systematic random sampling technique. Data was entered by Epi Info and analyzed by SPSS version 23. The association between variables was analyzed using bivariable and multivariable logistic regression model. P-value <0.05 at 95% CI was considered to be statistically significant. Results The proportion of episiotomy was 41.1% with 95% CI (36.5%, 46.2%). Multivariable logistic regression showed that primiparity (AOR=6.026, 95% CI (3.542,10.253)), prolonged second stage of labor (AOR=4.612, 95% CI (2.247,9.465)), instrument delivery (AOR =3.933, 95% CI (1.526,10.141)), using oxytocin (AOR=2.608, 95% CI (1.431,4.751)), medical resident attendant (AOR =3.225, 95% CI (1.409,7.382)) and birth weight ≥4000 grams (AOR=5.127,95% Cl (1.106,23.772)) were significantly associated with episiotomy practice. Conclusion The proportion of episiotomy was high. Parity, using oxytocin, second-stage labor duration, instrument delivery, birth weight, and delivery attendant were statistically significant factors for episiotomy practice. Therefore, as per our findings, we suggest awareness creation, and the setting and use of new national guidelines, the practice of routine episiotomy should be abandoned, and selective and restrictive use of episiotomy is highly advised.

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

“…Fetal macrosomia is common in obstetrics with problems in both the mother and newborn. The current review also showed that newborn birth weight ≥4,000 g was another risk factor associated with the practice of episiotomy compared with normal birth weight, which coincides with the findings reported in studies carried out in Ethiopia (53,54,57), France (51), and Nigeria (42,56,82). Other than newborns' , fetal macrosomia causes maternal complications during delivery, such as 3rd or 4th degree perineal tears (97,98).…”

“…On the contrary, the lowest rate of episiotomy, 9.3%, was reported in a study from Nigeria ( 40 ). In this meta-analysis, 17 of the 21 studies reported a percentage of episiotomy practice in primiparous and multiparous women ( 40 – 42 , 45 , 46 , 53 , 54 , 56 – 58 , 61 , 63 – 66 , 69 , 83 ), while the other four studies did not ( 55 , 82 , 84 , 85 ). The mean age of the study participants was not reported in ~66.7% of the studies ( 40 , 46 , 55 , 56 , 58 , 63 , 64 , 66 , 69 , 82 – 84 ).…”

“…The mean age of the study participants was not reported in ~66.7% of the studies ( 40 , 46 , 55 , 56 , 58 , 63 , 64 , 66 , 69 , 82 – 84 ). Among the studies that reported the age of the study subjects, the mean age of women for whom episiotomy was performed was 25.57 years ( 41 , 45 , 53 , 54 , 57 , 61 , 85 ). The year of publication of the included studies ranged from 2003 to 2021 ( Table 1 ).…”

“…According 55) episiotomy was significantly associated with a prolonged second stage of labor. Furthermore, macrosomia (42,51,53,54,(56)(57)(58), advanced gestational age (49,59,60), breech presentation (50,51,57,(60)(61)(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), postterm 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 <...…”

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

“…This group encompassed three studies. 25 , 30 , 33 Women with prolonged SSOL have 9.31 times (OR: 9.31, 95% CI: 5.34, 16.22) higher risk of episiotomy practice than those with a normal duration of SSOL. In this meta-analysis, included studies have some heterogeneity I 2 = 36.03%, p = 0.208.…”