<scp>FIGO</scp> Statement: Restrictive use rather than routine use of episiotomy

Nassar, Anwar H.; Visser, Gerard H.A.; Ayres‐de‐Campos, Diogo; Rane, Ajay; Gupta, Sandhya; Motherhood, Figo Safe

doi:10.1002/ijgo.12843

Cited by 29 publications

(21 citation statements)

References 26 publications

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“…The American College of Obstetricians and Gynecologists (ACOG) and Federation of International Gynecology and Obstetricians recommend that episiotomy should be done with judicious indication to lower perineal laceration with fewer complications [ 3 , 4 ]. Existing evidence also supported the recommendation to restrict episiotomy use [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Magnitude of Episiotomy and Associated Factors among Mothers Who Give Birth in Arba Minch General Hospital, Southern Ethiopia: Observation-Based Cross-Sectional Study

Fikadu

Boti

Tadesse

et al. 2020

Journal of Pregnancy

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Background. Episiotomy is the most common obstetric procedure, performed when the clinical circumstances place the patient at a high risk of high-degree laceration. However, episiotomy should be done with judicious indication to lower perineal laceration with fewer complications. Despite its adverse effects, the magnitude of episiotomy is increasing due to different factors. Therefore, this study is aimed at determining the recent magnitude of episiotomy and at identifying associated factors among women who gave delivery in Arba Minch General Hospital, Southern Ethiopia. Methods. An institution-based cross-sectional study was conducted from December 15, 2018, to January 30, 2019. A systematic random sampling technique was used to select study participants. A semistructured questionnaire was used to collect data. This was supplemented with a review of the labor and delivery records. Binary and multivariable logistic regression analyses were performed to identify factors associated with the magnitude of episiotomy. P value ≤ 0.05 was used to determine the level of statistically significant variables. Results. The magnitude of episiotomy was found to be 272 (68.0%) with 95%CI=64.0‐72.5. Women who attended secondary education [AOR=10.24, 95%CI=2.81‐37.34], women who attended college and above [AOR=4.61, 95%CI=1.27‐16.71], birth weight≥3000 g [AOR=4.84, 95%CI=2.66‐8.82], primipara [AOR=4.13, 95%CI=2.40‐7.12], being housewife occupants [AOR=3.43, 95%CI=1.20‐9.98], married women [AOR=2.86, 95%CI=1.40‐5.84], and body mass index<25 kg/m2 [AOR=2.85, 95%CI=1.50‐5.44] were independent variables found to have significant association with episiotomy. Conclusion. The magnitude of episiotomy was 68.0% which is higher than the recommended practice by WHO (10%). The study participants’ occupational status, marital status, educational status, parity, birth weight, and BMI were significantly associated with the magnitude of episiotomy in the study area. Therefore, to reduce the rate of episiotomy, it is better to have periodic training for birth attendants regarding the indication of episiotomy.

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Section: Introductionmentioning

confidence: 99%

Magnitude of Episiotomy and Associated Factors among Mothers Who Give Birth in Arba Minch General Hospital, Southern Ethiopia: Observation-Based Cross-Sectional Study

Fikadu

Boti

Tadesse

et al. 2020

Journal of Pregnancy

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“…There are some conflicting data regarding a policy of restricted episiotomy (episiotomy only when necessary) versus a policy of routine episiotomy regarding maternal and fetal outcomes. FIGO is clear in its support of restrictive rather than routine use of episiotomy 34 …”

Section: Episiotomymentioning

confidence: 99%

“…FIGO is clear in its support of restrictive rather than routine use of episiotomy. 34 When performing episiotomy, mediolateral episiotomy is generally recommended, 35 especially for AVD, where it appears to protect against OASI. A mediolateral episiotomy should be performed at 60 degrees.…”

Section: Epis Iotomymentioning

confidence: 99%

FIGO good clinical practice paper: management of the second stage of labor

Wright

Nassar

Visser

et al. 2021

Intl J Gynecology & Obste

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This good clinical practice paper provides an overview of the current evidence around second stage care, highlighting the challenges and the importance of maintaining highquality, safe, and respectful care in all settings. It includes a series of recommendations based on best available evidence regarding length of second stage, judicious use of episiotomy, and the importance of competent attendants and adequate resource to facilitate all aspects of second stage management, from physiological birth to assisted vaginal delivery and cesarean at full dilatation. The second stage of labor is potentially the most dangerous time for the baby and can have significant consequences for the mother, including death or severe perineal trauma or fistula, especially where there are failures to recognize and repair. This paper sets out principles of care, including the vital role of skilled birth attendants and birth companions, and the importance of obstetricians and midwives working together effectively and speaking with one voice, whether to women or to policy makers. The optimization of high-quality, safe, and personalized care in the second stage of labor for all women globally can only be achieved by appropriate attention to the training of birth attendants, midwives, and obstetricians. FIGO is committed to this aim, and will partner with WHO, ICM, and others, alongside our more than 130 member societies.

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“…5 The degree to which obstetric anal sphincter injury (OASI) is associated with the type and angle of episiotomy has been the subject of recent research and has led some experts to recommend mediolateral episiotomy, when episiotomy is indicated, to reduce risk of anal injury. 3,[8][9][10][11][12] Table 1 summarizes several international professional societies' and health organizations' recommendations for episiotomy use, indications, type, and mediolateral angle. The majority recommend restrictive use of episiotomy and mediolateral episiotomy over routine episiotomy and the median incision type.…”

Section: Introductionmentioning

confidence: 99%

Mediolateral Episiotomy: Technique, Practice, and Training

Hersh

Emeis

2020

J Midwife Womens Health

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Episiotomy is one of the most common obstetric procedures. However, restrictive use of episiotomy has led to a decrease in its use in the United States. Historically, mediolateral episiotomy has been performed less often than median episiotomy in the United States, but both have purported advantages and disadvantages. Emerging research on episiotomy and obstetric anal sphincter injuries has led to an examination of the effects of mediolateral episiotomy. This article describes performance of a mediolateral episiotomy in a situation of fetal bradycardia. Technical aspects of the incision and repair are described, and outcome data and knowledge gaps are summarized. Implications for practice, clinical competency, and education are reviewed.

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FIGO Statement: Restrictive use rather than routine use of episiotomy

Abstract: Restrictive rather than routine use of episiotomy should be exercised due to the potential short‐ and long‐term complications associated with episiotomy.

Cited by 29 publications

References 26 publications

Magnitude of Episiotomy and Associated Factors among Mothers Who Give Birth in Arba Minch General Hospital, Southern Ethiopia: Observation-Based Cross-Sectional Study

Magnitude of Episiotomy and Associated Factors among Mothers Who Give Birth in Arba Minch General Hospital, Southern Ethiopia: Observation-Based Cross-Sectional Study

FIGO good clinical practice paper: management of the second stage of labor

Mediolateral Episiotomy: Technique, Practice, and Training

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