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

Abstract

An episiotomy is one of the most commonly performed obstetrics surgeries indicated in emergencies during the second stage of labor like fetal distress, dystocia, and tight perineum. As a result, this systematic review and meta-analysis aimed to assess the prevalence of episiotomy practice and associated factors in Ethiopia. Ten cross-sectional studies with a total population of 3718 were included in this study. The search was done using online databases like PubMed, HINARI, Web of Science, other gray, and online repositories of Universities. All the included papers were extracted and appraised using the standard extraction sheet format of JOANNA Briggs Institute. The Cochran Q-test and I2 statistics test were used to test the heterogeneity of studies. To detect the publication bias of the included studies, a funnel plot and Egger’s test were used. The pooled prevalence of episiotomy practice and the odds ratio with a 95% confidence interval were presented using forest plots. The overall pooled prevalence of episiotomy practice was 45.11% (95% CI; 37.04–53.18; I2 = 96.3%). Prolonged second stage of labor (OR: 4.79, 95% CI: 3.03, 7.57), face presentation (OR: 4.26, 95% CI: 1.21, 15.07), birth weight > 4000 g (OR: 6.71, 95% CI: 3.14–14.33), instrumental delivery (OR: 4.26, 95% CI 2.95, 6.14), and primiparity (OR: 3.70, 95% CI: 1.90, 7.2) were factors associated with episiotomy practice. The overall prevalence of episiotomy practice was higher in Ethiopia compared to studies conducted in other countries. The prolonged second stage of labor, face presentation, birth weight > 4000 g, instrumental delivery, and primiparity of women were the factors associated with episiotomy practice. Therefore, efforts should be made to prevent routine episiotomy practice through creating awareness, adjusting national guidelines, affecting the World Health Organization episiotomy policy, and monitoring the activities of the health care facilities in executing the protocols.

The proportion of Episiotomy and Associated Factors among Mothers Who Gave Birth at Public Institutions, Northwest Ethiopia: A cross-sectional study

“…Women with face presentation during labor were 4.15 times more likely to have episiotomy than women with vertex presentation. This nding is consistent with another study done in Ethiopia [24,30]. This can be explained by the association between face presentation and di cult delivery which enforces health professionals to use episiotomy.…”

Effectiveness of small-angle episiotomy on incisional laceration rate, suturing time, and incisional bleeding in primigravida: A meta-analysis

“…Episiotomy, a widely used invasive procedure in obstetrics, is conditional and complex to perform ( 50 ). Major scientific groups, notably the World Health Organization, have explicitly cautioned against routine episiotomy and have reported frequent use of episiotomy without consent because of the additional risks associated with episiotomy, such as infection as well as vaginal discomfort, among others ( 51 , 52 ). This, along with other controversial and poorly regulated techniques such as hip pressure, has much to do with the definition of obstetric violence ( 53 ).…”

Postnatal perineal pain after vaginal delivery in comprehensive and specialised hospitals in Amhara regional state, Ethiopia, April to June, 2023

“…The most likely causes of post-natal perineal pain in women include perineal laceration, perineal tear, forceps or vacuum delivery, and surgical episiotomy (12,22,23). Women's primiparous and instrumental delivery were the factors associated with the use of surgical episiotomies (24). The severity of post-natal perineal pain caused by perineal traumas are commonly underestimated (21,25).…”