Prevalence of Episiotomy and Its Associated Factors in University of Gondar Comprehensive Specialized Referral Hospital: A Retrospective Study from Ethiopia

Abstract

Background: Episiotomy is a surgical incision of the perineum during delivery to enlarge the vaginal orifice. It is one of the most commonly performed obstetric intervention world widely. The magnitude of episiotomy varies from population to population. Limited information exists related to the practice of episiotomy in Ethiopia. This study aimed to assess the prevalence of episiotomy and its associated factors in University of Gondar Comprehensive Specialized Referral Hospital, Ethiopia. Methods: Institution based retrospective cross-sectional study was undertaken from March to June 2014 on 306 mothers who had a vaginal delivery in the Hospital. Systematic random sampling technique was employed to select study units. The data were collected using pretested cheek list. Proportion of patients who had episiotomy was calculated and the association between dependent and independent variables was checked using both binary and multiple logistic regression and Chi-square. Results: Prevalence of episiotomy in University of Gondar Comprehensive specialized Referral Hospital was 47.7% (n = 146). Majority (89.5%) of the delivery was spontaneous vaginal delivery while vacuum, forceps and destructive delivery were 4.6%, 4.6%, and 1.3% respectively. During pregnancy and delivery, 84% of mothers had no associated diseases while 8% had hypertensive disorder, 5% diabetes mellitus and 3% of them has other diseases. After multivariate analysis episiotomy was significantly associated with maternal age (15-24 years) (p = 0.041, AOR (CI 95%) 1.65 (1.02-2.66)), primiparity (p =0.010, AOR (CI 95%) 2.61 (1.54-4.44)), prolonged labor (p = 0.001, COR (CI 95%) 6.45 (2.89-14.38)), and weight of newborn (p = 0.044, COR (CI 95%) 2.48 (1.16, 5.31)). Conclusion: Prevalence of episiotomies in the institution was 47.7% and variables that remained associated significantly with episiotomy were maternal age, primiparity, prolonged labor, and newborn weight.

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

“…Moreover, mothers whose age group between 25 and 35 were 89% less likely to be exposed for episiotomy than mothers whose age group were between 18 and 24(AOR 0.11, 95% CI 0.05, 0.25). This result is consistent with the study conducted in Gondar Referral Hospital, Shire Town, Nigeria and Iran [ 42 , 54 , 70 , 71 ]. This might be suggests that loosen tenser (tight) musculature of multiparous for increased releasing period of cephalic pole presentation which in turn might not lead to health professionals to do episiotomy.…”

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

“…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 ).…”

“…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 ( …”

“…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)(40)(41)(42),Turkey (43), the United States (44), and Ethiopia (45,46), the odds of episiotomy practice were positively correlated with younger age at delivery. Nonetheless, advanced maternal age (≥35) was reported as an attributable factor in some studies (37,(47)(48)(49).…”