Statistical trends of episiotomy around the world: Comparative systematic review of changing practices

Clesse, Christophe; Lighezzolo-Alnot, Joëlle; Lavergne, Sylvie De; Hamlin, Sandrine; Scheffler, Michèle

doi:10.1080/07399332.2018.1445253

Cited by 59 publications

(57 citation statements)

References 39 publications

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“…The rates of episiotomy vary between countries. 6 One European study reported episiotomy rates from 3.7% in Denmark to 75% in Cyprus. 7 In Arab countries the rates of episiotomy are still high: 41.4% in Jordan, 8 52.2% in Saudi Arabia, 9 62% in Lebanon and 64% in United Arab Emirates.…”

Section: Introductionmentioning

confidence: 99%

Episiotomy practice in six Palestinian hospitals: a population-based cohort study among singleton vaginal births

et al. 2018

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ObjectiveTo explore the rates, characteristics and indications for episiotomy among women delivering vaginally for the first time, as well as parous women.Study designA prospective, population-based birth cohort study.SettingObstetric departments in six Palestinian government hospitals.ParticipantsAll women with singleton vaginal births (n=29 165) from 1 March 2015 until 1 March 2016.MethodsAll women were divided into two groups: first vaginal birth group (n=9108), including primiparous women and women with their first vaginal birth after one caesarean section, and the parous group (n=20 057). Each group was analysed separately. Data were presented as numbers and percentages or range. Differences in rates were assessed by the p values of χ2 test, or Fisher’s exact test if there are cell counts less than 5.Main outcome measuresEpisiotomy rates and indications among women of singleton births.ResultsThe overall episiotomy rate was 28.7%: 78.8% for women with first vaginal birth (range 56.6%–86.0%) and 5.9% for parous women (range 1.0%–9.5%). The most common indications for episiotomy were ‘primiparity’ in the first vaginal birth group (69.9%) and ‘protecting the perineum’ in the parous group (59.5%). The least common indications were prolonged second stage (1.5%) and fetal distress (6.9%), respectively.ConclusionIn Palestine, the majority of women who delivered vaginally for the first time had an episiotomy. Education of birth attendants, clinical audits, educational interventions and adherence to the updated guidelines may help to decrease the routine overuse of episiotomy.

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Section: Introductionmentioning

confidence: 99%

Episiotomy practice in six Palestinian hospitals: a population-based cohort study among singleton vaginal births

et al. 2018

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“…Como consecuencia de estas recomendaciones puede observarse una tendencia mundial a la disminución de su empleo (8)(9)(10)(11), hecho que es más visible en los países de altos ingresos, donde las tasas de episiotomía son inferiores al 30 %, mientras que en los países de menores ingresos pueden alcanzarse tasas superiores al 70 % (11).…”

Section: La Episiotomía En Mujeres Nulíparas: ¿Un Hábito Difícil De Dunclassified

La episiotomía en mujeres nulíparas: ¿un hábito difícil de dejar?

Rubio-Romero¹

2018

Rev. Colomb. Obstet. Ginecol.

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En el presente número de la Revista Colombiana de Obstetricia y Ginecología, se publica el estudio de Mellizo-Gaviria y colaboradores titulado “Frecuencia de la realización de episiotomía y complicaciones en el servicio de obstetricia del Hospital Universitario San José, Popayán (Colombia), 2016. Exploración de factores maternos y perinatales asociados a su realización”. Este estudio observacional de corte transversal buscó definir la frecuencia de uso de la episiotomía, sus complicaciones, y explorar algunos factores relacionados con su empleo durante la atención del parto. A partir de un muestreo aleatorio en una institución con una proporción de nacimientos por cesárea reportada en 2015 de 50%, encontraron una frecuencia de 30,5% en el empleo global de la episiotomía para los nacimientos a término, la cual se realizó en el 58,2 % de las mujeres nulíparas, mientras que solo se llevó a cabo en el 6,6 % de las mujeres multíparas. Como lo mencionan los autores, la nuliparidad incrementó más de ocho veces la probabilidad de realizar una episiotomía en las pacientes atendidas en la institución.

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“…This procedure was proposed to facilitate a quicker delivery of the baby, minimise risk of birth asphyxia, prevent severe laceration of the birth canal, and avoid injury to the pelvic floor . A recent systematic review assessing trends of episiotomy practice noted a remarkably wide variation in the frequency of performing episiotomy across countries ranging from only 5% in Denmark to more than 90% in some Asian countries . As with any surgical procedure, complications following episiotomy may occur.…”

Section: Introductionmentioning

confidence: 99%

Restrictive versus routine episiotomy among Southeast Asian term pregnancies: a multicentre randomised controlled trial

Sangkomkamhang

Kongwattanakul

Kietpeerakool

et al. 2019

BJOG

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Objective To determine whether restrictive or routine episiotomy in term pregnant Southeast Asian women results in fewer complications.Design A multicentre randomised controlled trial.Setting Two tertiary and two general hospitals in Thailand.Population 3006 singleton pregnant women 18 years or older, ≥37 weeks of gestation, cephalic presentation and planned vaginal delivery.Methods This randomised controlled trial compared routine versus restrictive episiotomies in Thai women giving birth vaginally. Participants were singleton, term pregnant women with cephalic presentation. Block randomisation was stratified by study site and parity. Risk ratios (RR) and 95% confidence intervals (CI) were calculated to indicate between-group differences.Main outcome measures Primary outcome was severe perineal laceration. Secondary outcomes included vaginal laceration, cervical laceration, and pregnancy outcomes.Results 3006 women were randomly assigned to restrictive (1502) and routine (1504) episiotomy. There was no difference in severe perineal laceration between the groups (RR 0.72, 95% CI 0.46-1.12). Restrictive episiotomy resulted in more intact perineums in multiparous women (RR 3.09, 95% CI 2.10-4.56). Restrictive episiotomy increased the risk of vaginal laceration in primiparous (RR 1.96, 95% CI 1.62-2.37) and multiparous women (RR 2.21, 95% CI 1.77-2.75) but did not lead to more suturing. There were comparable risks of cervical laceration, postpartum haemorrhage, wound complication, birth asphyxia, and admission to neonatal intensive care unit.Conclusions Restrictive episiotomy results in more intact perineum in multiparous women. Risks of maternal and neonatal outcomes were comparable between the two practices. These results strengthen the certainty of the existing Cochrane review findings in supporting restrictive episiotomy.Tweetable abstract Restrictive episiotomy results in more intact perineums after vaginal birth in multiparous Southeast Asian women.

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Statistical trends of episiotomy around the world: Comparative systematic review of changing practices

Cited by 59 publications

References 39 publications

Episiotomy practice in six Palestinian hospitals: a population-based cohort study among singleton vaginal births

Episiotomy practice in six Palestinian hospitals: a population-based cohort study among singleton vaginal births

La episiotomía en mujeres nulíparas: ¿un hábito difícil de dejar?

Restrictive versus routine episiotomy among Southeast Asian term pregnancies: a multicentre randomised controlled trial

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