Influence of the maternity unit and region of delivery on episiotomy practice in France: a nationwide population-based study

Frequency of episiotomy practice in an institution in Quito, Ecuador 2009-2022

Objectives

To determine the prevalence of episiotomy over a 14-year period and to explore its association with maternal, delivery, and neonatal variables using administrative data.

Material and methods

This is a cross-sectional study. Women who had a vaginal delivery with a live newborn at a referral hospital for obstetric care in Ecuador were included. Consecutive sampling was employed. ICD-10 records and the perinatal information system (PIS) were utilized. Sociodemographic, gestational, delivery, and neonatal variables were assessed. Descriptive analysis was performed. The overall and yearly prevalence was determined. Exploratory bivariate and multivariate analyses were conducted. The study was approved by the Human Research Ethics Committee of the Universidad Central del Ecuador.

Results

A total of 11,862 records were analyzed. The overall prevalence of episiotomy was 36.69 %, with a maximum of 42 % and a minimum of 28 %. There is an implied trend towards a reduction in frequency from 2019 to 2022. A positive association was found between episiotomy and maternal age under 20 years, previous cesarean section, absence of a companion during delivery, term newborns, and large for gestational age newborns. A negative association was found with previous vaginal deliveries.

Conclusions

The prevalence of episiotomy exceeds the recommendation of the World Health Organization (WHO). Clinical practice guidelines should consider potentially modifiable maternal and neonatal factors in their recommendations. Prospective studies should be conducted to evaluate the safety of the procedure, confirm these observations, and use robust methodologies to assess if there is a real decrease in its practice.

A Systematic Review of the Use of Routine Versus Selective Episiotomy for Vaginal Birth

Episiotomy is a common obstetric surgical procedure involving an incision to enlarge the vaginal opening, facilitating the delivery of the fetus during the second stage of labor. Hence, the current review was conducted to assess the impact of using selective versus routine episiotomy during vaginal birth on birth outcomes. This systematic review used the Joanna Briggs Institute (JBI) methodology for systematic reviews and research syntheses. PubMed, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and SCOPUS were searched for relevant studies. Two reviewers independently screened and extracted data from relevant studies. Four studies met the eligibility criteria and were included in this review. The findings suggest selective episiotomy is associated with better maternal and fetal outcomes than routine episiotomy in certain contexts. However, results varied, indicating the importance of tailoring episiotomy practices to specific patient populations and healthcare settings. To conclude, the review supports the use of selective episiotomy over routine episiotomy during vaginal birth, as it is associated with fewer adverse maternal outcomes.

Obstetric Interventions Among Native and Migrant Women: The (Over)use of Episiotomy in Portugal

Objective: Episiotomy, defined as the incision of the perineum to enlarge the vaginal opening during childbirth, is one of the most commonly performed surgical interventions in the world. We aimed to determine if migrant status is associated with episiotomy, and if individual characteristics mediate this association. Methods: We analyzed data from the Bambino study, a national, prospective cohort of migrant and native women giving birth at a public hospital in mainland Portugal between 2017 and 2019. We included all women with vaginal delivery. The association between migrant status and episiotomy was assessed using multivariable multilevel random-effect logistic regression models. We used path analysis to quantify the direct, indirect and total effects of migrant status on episiotomy. Results: Among 3,583 women with spontaneous delivery, migrant parturients had decreased odds of episiotomy, especially those born in Africa, compared to native Portuguese women. Conversely, with instrumental delivery, migrant women had higher odds of episiotomy. Disparities in episiotomy were largely explained by maternity units' factors, and little by maternal and fetal characteristics. Conclusion: Our results suggest non-medically justified differential episiotomy use during childbirth and highlight the importance of developing evidence-based recommendations for episiotomy use in a country with a high frequency of medical interventions during delivery.