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Belay T, Semahegn A, Mezmur H, Mulatu T. Prevalence of episiotomy and associated factors among women who gave birth at public health facilities in Jigjiga town, eastern Ethiopia: A cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003216. [PMID: 38768152 PMCID: PMC11104620 DOI: 10.1371/journal.pgph.0003216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 04/16/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Maternal morbidity and mortality has remained a major public health concern worldwide. Basic emergency obstetric care is the primary intervention to prevent obstetric complications and maternal death. Episiotomy is one of the basic obstetrical procedures used to facilitate vaginal delivery, shorten the second stage of labor and prevent complications. However, there is a paucity of evidence on the prevalence and factors associated with episiotomy among women who gave birth in eastern Ethiopia. OBJECTIVE This study aimed to determine the prevalence of episiotomy and its associated factors among women who gave birth at public health facilities in Jigjiga town, eastern Ethiopia. METHODS A facility-based cross-sectional study was conducted among women who gave birth vaginally from May 1 to June 30, 2022. A total of 422 study participants were recruited using systematic random sampling. Data were collected using structured questionnaires through a face-to-face interview supported with standard observational checklist and reviewing medical records. A logistic regression analysis was carried out to examine the association between explanatory variables and episiotomy. An adjusted odds ratio (AOR) at a 95% confidence interval (CI) at a P-value <0.05 was used to declare significant association. RESULTS The prevalence of episiotomy among women was 52.6% (95% CI: 47.8%, 57.0%). Obstetric complications during current pregnancy (AOR:3.92, 95% CI: 1.59, 9.68), birth weight ≥4000 gm (AOR: 4.30, 95% CI: 1.53, 12.04), induction of labor (AOR: 3.10, 95% CI: 1.62, 5.93), meconium-stained amniotic fluid (AOR:2.10, 95% CI: 1.14, 3.88), duration of the second stage of labor ≥90 minutes (AOR:3.09, 95% CI: 1.53, 6.23), instrumental delivery (AOR: 2.69, 95%, CI: 1.39, 5.19), and female genital mutilation (AOR: 2.91, 95% CI: 1.83, 4.64) were factors significantly associated with episiotomy. CONCLUSION Slightly more than half of the women who gave birth at public health facilities in the study area underwent episiotomies. In addition to the common obstetric factors, having a female genital mutilation scar increased the risk of women's experiencing episiotomies. Therefore, intervention should be tailored to address the identified obstetric risk factors and avoid female genital mutilation in the community to reduce women's experiences of episiotomies in the future.
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Affiliation(s)
- Tamene Belay
- Department of Midwifery, College of Medicine and Health Sciences, Jigjiga University, Jigjiga, Ethiopia
| | - Agumasie Semahegn
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Haymanot Mezmur
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Teshale Mulatu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Alsuraykh LA, Alnadawi AA, Alharbi A, Alhumaidi KA, Alhabardi N, Almarshud R. Women's Perceptions and Knowledge Toward Episiotomy in Qassim Region, Saudi Arabia. Cureus 2024; 16:e55383. [PMID: 38562338 PMCID: PMC10984130 DOI: 10.7759/cureus.55383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Episiotomy, despite being one of the most common interventions during childbirth, carries significant risks and uncertain benefits. Previous global studies highlight varying awareness levels and practices, with decreasing episiotomy rates attributed to increased knowledge. This study aims to assess women's knowledge to enhance intrapartum decision-making and communication between patients and obstetricians, ultimately improving maternal outcomes in the region. METHODOLOGY The study was a cross-section design. It was conducted through an online survey that was distributed by different social media platforms (Twitter, WhatsApp, and Telegram) from February 2023 to January 2024. It included women living in the Qassim region, Saudi Arabia, who were 15 years old or older. Data was analyzed using the SPSS program (IBM, Chicago, Illinois, USA). RESULTS Among the 402 participants, 62.7% demonstrated awareness of episiotomy, with 94.0% accurately identifying it as a surgical cutting with scissors. About 82.5% acknowledged that not all women require episiotomies, while 48.8% recognized the necessity of anesthesia before the procedure. Understanding the indications for episiotomy varied, with facilitating and accelerating childbirth (64.3%) and dealing with a large baby (62.3%) being the most recognized reasons. Impressively, 90.5% believed that there are methods to avoid perineal cutting, with knowing the correct mechanism for pushing during childbirth (69.4%) and exercise (54.4%) being the most acknowledged preventive measures. Regarding post-cutting care, antibiotics (61.5%) were identified as essential, followed by analgesia (52.8%) and laxatives (48.8%). CONCLUSION The study reveals a notable awareness among participants, with a majority demonstrating a solid understanding of the procedure, its indications, and post-procedure care. It identified specific knowledge gaps, such as the need for anesthesia awareness and divergent beliefs about post-episiotomy care practices.
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Affiliation(s)
- Lubna A Alsuraykh
- Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Aseel A Alnadawi
- Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Aeshah Alharbi
- Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Kadi A Alhumaidi
- Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Nadiyah Alhabardi
- Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Raghad Almarshud
- General Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
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Faden YA, Fatani AM, Fallatah BM, Rawa TS, Almasri SA, El Amin NO, Rawas SA, Al-Hindi MY. Examining the Association Between Episiotomy and Severe Perineal Tears in a Tertiary Care Center Implementing a Restrictive Episiotomy Policy. Cureus 2022; 14:e31606. [DOI: 10.7759/cureus.31606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 11/19/2022] Open
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Deyaso ZF, Chekole TT, Bedada RG, Molla W, Uddo EB, Mamo TT. Prevalence of episiotomy practice and factors associated with it in Ethiopia, systematic review and meta-analysis. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221091659. [PMID: 35435068 PMCID: PMC9019356 DOI: 10.1177/17455057221091659] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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.
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Affiliation(s)
- Zerihun Figa Deyaso
- Department of Midwifery, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
- Zerihun Figa Deyaso, Department of Midwifery, College of Health and Medical Science, Dilla University, Dilla, 419, Ethiopia.
| | - Tesfaye Temesgen Chekole
- Department of Midwifery, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
| | - Rediet Gido Bedada
- Department of Midwifery, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
| | - Wondwosen Molla
- Department of Midwifery, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
| | - Etaferahu Bekele Uddo
- Department of Emergency Critical Nursing, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
| | - Tizalegn Tesfaye Mamo
- Department of Epidemiology, College of Health and Medical Science, School of Public Health, Dilla University, Dilla, Ethiopia
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Incidences of Atonic Postpartum Hemorrhage and Related Risk Factors at a Tertiary Hospital in Saudi Arabia. NURSING REPORTS 2020; 10:164-171. [PMID: 34968361 PMCID: PMC8608049 DOI: 10.3390/nursrep10020020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/24/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022] Open
Abstract
Background: In 2017, there were 295,000 maternal deaths worldwide from preventable causes related to birth. The leading cause of maternal mortality is obstetric hemorrhage. In Saudi Arabia, a paucity of evidence about incidences of atonic Postpartum Hemorrhage (PPH) and related risk factors exists. Therefore, aims were to (a) identify incidences of atonic PPH from 2015 to 2018 (b) determine risk factors of atonic PPH in vaginal birth. Methods: Retrospective chart review with purposive sampling conducted revealed 386 charts, 220 (57%) vaginal birth and 166 (43%) caesarian section (CS). Logistic regression analysis was used. Results: Incidences of atonic PPH were 2.5% from 2015 to 2017, with the rate increasing by 12% from 2017 to 2018. In vaginal birth, significant associations between the severity of blood loss with epidural (F = 6.314, df = 1, p = 0.013), episiotomy (F = 4.38, df = 1, p = 0.038), induction of labor (IOL) (F = 1.224, df = 1, p = 0.004), and Interaction between IOL, AUG, and epidural (F = 7.24, df = 1, p = 0.041) found. Discussion: Increasing rate of atonic PPH confirmed. Epidural, episiotomy, induction of labor, and induction with augmentation are factors associated with severe atonic PPH in vaginal birth.
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Zaami S, Zupi E, Lazzeri L, Centini G, Stark M, Malvasi A, Signore F, Marinelli E. Episiotomy: a medicolegal vicious cycle. Panminerva Med 2020; 63:224-231. [PMID: 32414232 DOI: 10.23736/s0031-0808.20.03946-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present study aimed to analyze the litigation trends and ensuing compensatory damages brought about by the use of episiotomy, in order to outline a set of cautionary rules meant to limit the scope of legreal aftermath for both doctors and health care facilities. The authors have set out to gain an insight into the controversial practice of episiotomy, in light of available research data and official positions of various scientific and medical associations, with a close focus on the legal and medical viability of the procedure itself. Court data and trial records have been taken into account as well, via searches into legal databases and search engines (Justia, Lexis, Jurist.org, Venice Courthouse, etc.). This review showed that most episiotomy-related lawsuits stemmed from a routine use of that procedure, which is almost universally advised against, and without valid informed consent having been gained. Ultimately, authors have seen fit to underscore the need for patients potentially eligible for an episiotomy (selective episiotomy) to receive thorough and understandable information in a timely fashion including the necessity and the effectiveness of the procedure as well as the risks involved, so that a well-informed decision can be made based on factual data.
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Affiliation(s)
- Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University, Rome, Italy -
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Michael Stark
- The New European Surgical Academy (NESA), Berlin, Germany.,ELSAN Group Hospitals, Paris, France
| | - Antonio Malvasi
- Department of Applied Mathematics, Institute of Physics and Technology, State University, Moscow, Russia.,Department of Obstetrics and Gynecology, GVM Care and Research, Santa Maria Hospital, Bari, Italy
| | - Fabrizio Signore
- Department of Obstetrics and Gynecology, Misericordia Hospital, Grosseto, Italy
| | - Enrico Marinelli
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University, Rome, Italy
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Jankovic SM, Masic I. Evaluation of Preclinical and Clinical Studies Published in Medical Journals of Bosnia and Herzegovina: Methodology Issues. Acta Inform Med 2020; 28:4-11. [PMID: 32210508 PMCID: PMC7085328 DOI: 10.5455/aim.2020.28.4-11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/12/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Results of preclinical and clinical studies in medicine could be trusted only if their design and statistical analysis were appropriate. AIM The aim of our study was to investigate whether preclinical and clinical studies published in medical journals of Bosnia and Herzegovina satisfy basic requirements for appropriate design and statistical interpretation of data. METHODS Preclinical and clinical studies published in medical journals of Bosnia and Herzegovina were retrieved from the PubMed database, and the sample for analysis was randomly chosen from the retrieved publications. Implementation rate of basic principles of experimental design (local control, randomization and replication) and rate of the most common errors in design of clinical/observational studies was established by careful reading of the sampled publications and their checking against predefined criteria. RESULTS Our study showed that only a minority of experimental preclinical studies had basic principles of design completely implemented (7%), while implementation rate of single aspects of appropriate experimental design varied from as low as 12% to as high as 77%. Only one of the clinical/observational studies had none of the errors searched for (2%), and specific errors rates varied from 10% to 89%. Average impact factor of the surveyed studies was around one, and average publication date recent, less than 5 years ago. CONCLUSION Prevalence of preclinical studies that did not follow completely basic principles of research design, and that of clinical/observational studies with errors are high, raising suspicion to validity of their results. If incorrect and not protected against bias, results of published studies may adversely influence future research.
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Affiliation(s)
| | - Izet Masic
- Academy of Medical Sciences of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
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Masuda C, Ferolin SK, Masuda K, Smith C, Matsui M. Evidence-based intrapartum practice and its associated factors at a tertiary teaching hospital in the Philippines, a descriptive mixed-methods study. BMC Pregnancy Childbirth 2020; 20:78. [PMID: 32024504 PMCID: PMC7003416 DOI: 10.1186/s12884-020-2778-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/29/2020] [Indexed: 12/03/2022] Open
Abstract
Background Evidenced-based practice is a key component of quality care. However, studies in the Philippines have identified gaps between evidence and actual maternity practices. This study aims to describe the practice of evidence-based intrapartum care and its associated factors, as well as exploring the perceptions of healthcare providers in a tertiary hospital in the Philippines. Methods A mixed-methods study was conducted, which consisted of direct observation of intrapartum practices during the second and third stages, as well as semi-structured interviews and focus group discussions with care providers to determine their perceptions and reasoning behind decisions to perform episiotomy or fundal pressure. Univariate and multivariate logistic regression were used to analyse the relationship between observed practices and maternal, neonatal, and environmental factors. Qualitative data were parsed and categorised to identify themes related to the decision-making process. Results A total of 170 deliveries were included. Recommended care, such as prophylactic use of oxytocin and controlled cord traction in the third stage, were applied in almost all the cases. However, harmful practices were also observed, such as intramuscular or intravenous oxytocin use in the second stage (14%) and lack of foetal heart rate monitoring (57%). Of primiparae, 92% received episiotomy and 31% of all deliveries received fundal pressure. Factors associated with the implementation of episiotomy included primipara (adjusted Odds Ratio [aOR] 62.3), duration of the second stage of more than 30 min (aOR 4.6), and assisted vaginal delivery (aOR 15.0). Factors associated with fundal pressure were primipara (aOR 3.0), augmentation with oxytocin (aOR 3.3), and assisted delivery (aOR 4.8). Healthcare providers believe that these practices can prevent laceration. The rate of obstetric anal sphincter injuries (OASIS) was 17%. Associated with OASIS were assisted delivery (aOR 6.0), baby weights of more than 3.5 kg (aOR 7.8), episiotomy (aOR 26.4), and fundal pressure (aOR 6.2). Conclusions Our study found that potentially harmful practices are still conducted that contribute to the occurrence of OASIS. The perception of these practices is divergent with current evidence, and empirical knowledge has more influence. To improve practices the scientific evidence and its underlying basis should be understood among providers.
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Affiliation(s)
- Chisato Masuda
- Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Sakamoto 1-12-4, Nagasaki, 852-8523, Japan
| | - Shirley Kristine Ferolin
- Department of Obstetrics and Gynaecology, Southern Philippines Medical Centre, JP Laurel Avenue, Bajada, Davao City, 8000, The Philippines
| | - Ken Masuda
- Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Sakamoto 1-12-4, Nagasaki, 852-8523, Japan
| | - Chris Smith
- Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Sakamoto 1-12-4, Nagasaki, 852-8523, Japan.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E7HT, UK
| | - Mitsuaki Matsui
- Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Sakamoto 1-12-4, Nagasaki, 852-8523, Japan.
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Desplanches T, Szczepanski E, Cottenet J, Semama D, Quantin C, Sagot P. A novel classification for evaluating episiotomy practices: application to the Burgundy perinatal network. BMC Pregnancy Childbirth 2019; 19:300. [PMID: 31419953 PMCID: PMC6698013 DOI: 10.1186/s12884-019-2424-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/24/2019] [Indexed: 11/24/2022] Open
Abstract
Background Though the rate of episiotomy has decreased in France, the overall episiotomy rate was 20% in the 2016 national perinatal survey. We aimed to develop a classification to facilitate the analysis of episiotomy practices and to evaluate whether episiotomy is associated with a reduction in the rate of obstetric anal sphincter injuries (OASIS) for each subgroup. Methods This population-based study included all the deliveries that occurred in the Burgundy Perinatal Network from 2011 to 2016. The main outcome was episiotomy, which was identified thanks to the French Common Classification of Medical Procedures. An ascending hierarchical cluster analysis was performed to build the classification. A clinical audit using the classification was conducted yearly in all obstetric units. The episiotomy rates were described throughout the study period for each subgroup of the classification. The OASIS rates were evaluated by subgroup and the association between mediolateral episiotomy and OASIS was investigated for each subgroup. Results Our analyses included 81,290 pregnant women. The classification comprised 7 subgroups: (1) nulliparous single cephalic at term, (2) nulliparous single cephalic at term with instrumental delivery, (3) multiparous single cephalic at term, (4) multiparous single cephalic at term with instrumental delivery, (5) all preterm deliveries (< 37 weeks gestation), (6) all breech deliveries, (7) all multiple deliveries. Episiotomy rates ranged from 6.2% in Group 3 to 40.9% in Group 2. From 2011 to 2016, every group except breech deliveries experienced a significant decrease in episiotomy rates, ranging from − 28.1 to − 61.0%. The prevalence of OASIS was the highest in Groups 2 (3.0%) and 4 (2.2%). Overall OASIS rates did not significantly differ with episiotomy use (P = 0.25). However, we found that the use of episiotomy was associated with a reduction in OASIS rates in Groups 1 and 2 (odds ratio 0.6 [95% CI 0.4–0.9] and 0.4 [0.3–0.5], respectively). This reduction was only observed in Group 4 with forceps delivery (odds ratio 0.4 [0.1–0.9]). Conclusion We developed the first classification for the evaluation of episiotomy practices based on 7 clinically relevant subgroups. This easy-to-use tool can help obstetricians and midwives improve their practices through self-assessment. Electronic supplementary material The online version of this article (10.1186/s12884-019-2424-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thomas Desplanches
- CHRU Dijon, Department of gynecology, obstetrics, fetal medicine and infertility, Dijon, France. .,Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France, Paris Descartes University, Paris, France.
| | - Emilie Szczepanski
- CHRU Dijon, Department of gynecology, obstetrics, fetal medicine and infertility, Dijon, France
| | - Jonathan Cottenet
- Service de Biostatistique et d'Informatique Médicale (DIM), Dijon University Hospital, F-21000, Dijon, France.,Inserm, CIC 1432, Clinical Epidemiology Unit Dijon, France; Clinical Investigation Center, Clinical Epidemiology Unit, Dijon University Hospital, Dijon, France
| | - Denis Semama
- CHRU Dijon, Department of Neonatal Pediatrics, Dijon University Hospital, Dijon, France
| | - Catherine Quantin
- Service de Biostatistique et d'Informatique Médicale (DIM), Dijon University Hospital, F-21000, Dijon, France.,Inserm, CIC 1432, Clinical Epidemiology Unit Dijon, France; Clinical Investigation Center, Clinical Epidemiology Unit, Dijon University Hospital, Dijon, France.,Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Paul Sagot
- CHRU Dijon, Department of gynecology, obstetrics, fetal medicine and infertility, Dijon, France.,University of Burgundy, Dijon, France
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Zimmo KM, Laine K, Fosse E, Zimmo M, Ali-Masri H, Böttcher B, Zucknick M, Vikanes Å, Hassan S. Impact of animated instruction on tablets and hands-on training in applying bimanual perineal support on episiotomy rates: an intervention study. Int Urogynecol J 2018; 30:1343-1350. [PMID: 30008080 PMCID: PMC6647226 DOI: 10.1007/s00192-018-3711-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/20/2018] [Indexed: 11/27/2022]
Abstract
Introduction and hypothesis In Palestine, episiotomy is frequently used among primiparous women.This study assesses the effect of training birth attendants in applying bimanual perineal support during delivery by either animated instruction on tablets or hands-on training on episiotomy rates among primiparous women. Methods An interventional cohort study was performed from 15 October 2015 to 31 January 2017, including all primiparous women with singletons and noninstrumental vaginal deliveries at six Palestinian hospitals. Intervention 1 (animated instructions on tablets) was conducted in Hospitals 1, 2, 3, and 4. Intervention 2 (bedside hands-on training) was applied in Hospitals 1 and 2 only. Hospitals 5 and 6 did not receive interventions. Differences in episiotomy rates in intervention and nonintervention hospitals were assessed before and after the interventions and presented as p values using chi-square test, and odds ratios (OR) with 95% confidence intervals (CI). Differences in the demographic and obstetric characteristics were presented as p values using the Kruskal–Wallis test. Results Of 46,709 women, 12,841 were included. The overall episiotomy rate in the intervention hospitals did not change significantly after intervention 1, from 63.1 to 62.1% (OR = 0.96, 95% CI 0.84–1.08), but did so after intervention 2, from 61.1 to 38.1% (OR = 0.39, 95% CI 0.33–0.47). Rates after Intervention 2 changed from 65.0 to 47.3% (OR = 0.52, 95% CI 0.40–0.67) in Hospital 1 and from 39.4 to 25.1% (OR = 0.49, 95% CI 0.35–0.68) in Hospital 2. Conclusions Hands-on training of bimanual perineal support during delivery of primiparous women was significantly more effective in reducing episiotomy rates than animated instruction videos alone. Electronic supplementary material The online version of this article (10.1007/s00192-018-3711-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kaled Mikki Zimmo
- Department of Obstetrics, Al Aqsa Hospital, Gaza, Palestine.
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, 4950 Nydalen, 0424, Oslo, Norway.
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Katariina Laine
- Department of Health Management and Health Economics, Institute for Health and Society, University of Oslo, Oslo, Norway
- Department of Obstetrics, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Erik Fosse
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, 4950 Nydalen, 0424, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Mohammed Zimmo
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, 4950 Nydalen, 0424, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Obstetrics, Al Shifa Hospital, Gaza, Palestine
| | - Hadil Ali-Masri
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, 4950 Nydalen, 0424, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Obstetrics, Palestine Medical Complex, Ramallah, Palestine
| | - Bettina Böttcher
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Manuela Zucknick
- Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
| | - Åse Vikanes
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, 4950 Nydalen, 0424, Oslo, Norway
| | - Sahar Hassan
- Departement of Nursing, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, Palestine
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Zimmo K, Laine K, Fosse E, Zimmo M, Ali-Masri H, Zucknick M, Vikanes Å, Hassan S. Episiotomy practice in six Palestinian hospitals: a population-based cohort study among singleton vaginal births. BMJ Open 2018; 8:e021629. [PMID: 30012790 PMCID: PMC6082490 DOI: 10.1136/bmjopen-2018-021629] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore the rates, characteristics and indications for episiotomy among women delivering vaginally for the first time, as well as parous women. STUDY DESIGN A prospective, population-based birth cohort study. SETTING Obstetric departments in six Palestinian government hospitals. PARTICIPANTS All women with singleton vaginal births (n=29 165) from 1 March 2015 until 1 March 2016. METHODS All 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 MEASURES Episiotomy rates and indications among women of singleton births. RESULTS The 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. CONCLUSION In 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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Affiliation(s)
- Kaled Zimmo
- Department of Obstetrics, Al Aqsa Hospital, Gaza, Palestine
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Katariina Laine
- Department of Obstetrics, Oslo University Hospital, Oslo, Norway
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Erik Fosse
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mohammed Zimmo
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Department of Obstetrics, Al Shifa Hospital, Gaza, Palestine
| | - Hadil Ali-Masri
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Department of Obstetrics, Palestine Medical Complex, Ramallah, Palestine
| | - Manuela Zucknick
- Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
| | - Åse Vikanes
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Sahar Hassan
- Department of Nursing, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, Palestine
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Gebuza G, Kaźmierczak M, Gdaniec A, Mieczkowska E, Gierszewska M, Dombrowska-Pali A, Banaszkiewicz M, Maleńczyk M. Episiotomy and perineal tear risk factors in a group of 4493 women. Health Care Women Int 2018; 39:663-683. [PMID: 29648935 DOI: 10.1080/07399332.2018.1464004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Episiotomy belongs to the most frequent procedures carried out during delivery. Performing episiotomy should be reduced as there is scientific evidence indicating that it can cause pain, sexual problems, and serious, long-term health consequences. The aim of the researchers is to identify factors associated with episiotomy and the perineal tear. Analyses were performed using a model of a logistic regression. The study involved 4493 women. The episiotomy risk was related to: a birth weight exceeding 3500 grams, an instrumental delivery by means of forceps or vacuum extraction. The decrease of episiotomy rate increased the rate of perineal tear of first and second degree. The study has shown that episiotomy protects women from third- and fourth-degree perineal tear.
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Affiliation(s)
- Grażyna Gebuza
- a Faculty of Health Sciences, Nicolaus Copernicus University Torun , Tourn , Poland
| | - Marzena Kaźmierczak
- a Faculty of Health Sciences, Nicolaus Copernicus University Torun , Tourn , Poland
| | - Alicja Gdaniec
- a Faculty of Health Sciences, Nicolaus Copernicus University Torun , Tourn , Poland
| | - Estera Mieczkowska
- a Faculty of Health Sciences, Nicolaus Copernicus University Torun , Tourn , Poland
| | | | | | | | - Marek Maleńczyk
- b Obstetrics, Feminine Health, and Oncologic Gynecology Unit, District Hospital , Torun , Poland
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Zaidan A, Hindi M, Bishara A, Alolayan S, Abduljabbar H. The Awareness Regarding the Episiotomy Procedure Among Women in Saudi Arabia. Mater Sociomed 2018; 30:193-197. [PMID: 30515058 PMCID: PMC6195407 DOI: 10.5455/msm.2018.30.193-197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Episiotomy is an intended incision made through the perineal body to enlarge the vaginal orifice during the second stage of labor to ease the parturition. A cross sectional study in Jeddah, Saudi Arabia, showed that 35% of the females in 2012 had an episiotomy, this slightly increased in 2015 to (36.4%). Given the increase rates of episiotomy and the significance of patients’ awareness, there were very limited data on the awareness of episiotomy among women. Aim: Aim of this study is to estimate the extent of the awareness regarding the episiotomy procedure among women in Saudi Arabia. Material and methods: Participants aged 15 and above filled a questionnaire distributed online to different regions of Saudi Arabia. Descriptive statistics were used. Results: a total of 626 women participated in this study with a mean age 34.7 years. The majority (63.6%) of women reported being informed about the procedure. Still, only (40%) of them were able to describe the procedure correctly. Only age, parity and history of previous episiotomy were predictors for episiotomy awareness. Women aged 35 or less were more aware of episiotomy than those aged more than 35 with a p-value (<0.001). However, the multigravida were more aware of episiotomy than primigravida with a p-value (< 0.001). Conclusion: The awareness of episiotomy is still not accomplish in Saudi Arabia, which poses the need for further modalities to educate women and increase their awareness regarding selective episiotomy rather than the old method of routine episiotomy.
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Affiliation(s)
- Asma Zaidan
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Muhab Hindi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Ahmed Bishara
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Samar Alolayan
- Obstetrics and Gynecology Department, Faculty of Medicine, Jeddah University, Jeddah, Kingdom of Saudi Arabia
| | - Hassan Abduljabbar
- Obstetrics and Gynecology Department, Faculty of Medicine, Jeddah University, Jeddah, Kingdom of Saudi Arabia
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