Article

Episiotomy in the United States: has anything changed? REPLY

Division of Urogynecology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
American journal of obstetrics and gynecology (Impact Factor: 3.97). 03/2009; 200(5):573.e1-7. DOI: 10.1016/j.ajog.2008.11.022
Source: PubMed

ABSTRACT The objective of the study was to describe episiotomy rates in the United States following recommended changes in clinical practice.
The National Hospital Discharge Survey, a federal data set sampling inpatient hospitals, was used to obtain data based on International Classification of Diseases, Clinical Modification, 9th revision, diagnosis and procedure codes from 1979 to 2004. Age-adjusted rates of term, singleton, vertex, live-born spontaneous vaginal delivery, operative vaginal delivery, cesarean delivery, episiotomy, and anal sphincter laceration were calculated. Census data for 1990 for women 15-44 years of age was used for age adjustment. Regression analysis was used to evaluate trends in episiotomy.
The rate of episiotomy with all vaginal deliveries decreased from 60.9% in 1979 to 24.5% in 2004. Anal sphincter laceration with spontaneous vaginal delivery declined from 5% in 1979 to 3.5% in 2004. Rates of anal sphincter laceration with operative delivery increased from 7.7% in 1979 to 15.3% in 2004. The age-adjusted rate of operative vaginal delivery declined from 8.7 in 1979 to 4.6 in 2004, whereas cesarean delivery rates increased from 8.3 in 1979 to 17.2 per 1000 women in 2004.
Routine episiotomy has declined since liberal usage has been discouraged. Anal sphincter laceration rates with spontaneous vaginal delivery have decreased, likely reflecting the decreased usage of episiotomy. The decline in operative vaginal delivery corresponds to a sharp increase in cesarean delivery, which may indicate that practitioners are favoring cesarean delivery for difficult births.

0 Followers
 · 
137 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Episiotomy remains a routine procedure at childbirth in many South-East Asian countries but the reasons for this are unknown. The aim of this study was to determine the knowledge of, attitudes towards and experience of episiotomy use among clinicians in Viet Nam. All obstetricians and midwives who provide delivery care at Hung Vuong Hospital were surveyed about their practice, knowledge and attitudes towards episiotomy use. Data were analysed using frequency tabulations and contingency table analysis. 148 (88%) clinicians completed the questionnaire. Fewer obstetricians (52.2%) than midwives (79.7%) thought the current episiotomy rate of 86% was about right (P < 0.01). Most obstetricians (82.6%) and midwives (98.7%) reported performing episiotomies on nulliparous women over 90% of the time. Among multipara, 24.6% of obstetricians reported performing episiotomy less than 60% of the time compared with only 3 (3.8%) midwives (P < 0.01). Aiming to reduce 3rd-4th degree perineal tears was the most commonly reported reason for performing an episiotomy by both obstetricians (76.8%) and midwives (82.3%), and lack of training in how to minimize tears and keep the perineum intact was the mostly commonly reported obstacle (obstetricians 56.5%, midwives 36.7% P = 0.02) to reducing the episiotomy rate. Although several factors that may impede or facilitate episiotomy practice change were identified by our survey, training and confidence in normal vaginal birth without episiotomy is a priority.
    BMC Pregnancy and Childbirth 04/2015; 15(1):101. DOI:10.1186/s12884-015-0531-2 · 2.15 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: http://www.biomedcentral.com/content/pdf/s12913-015-0753-z.pdf
    BMC Health Services Research 03/2015; 15(95). DOI:10.1186/s12913-015-0753-z · 1.66 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A episiotomia é uma pratica obstétrica frequentemente realizada como rotina na assistência ao parto, embora evidências científicas demonstram que sua realização sem real indicação pode resultar em complicações maternas. Além de ser em grande parte dos casos desnecessária, a episiotomia é considerada uma violência obstétrica, visto que geralmente esse procedimento é realizado sem devido esclarecimento à parturiente e sem o seu consentimento, provocando perda de autonomia e do poder de decisão sobre seu próprio corpo. O objetivo deste trabalho é relatar um caso de violência obstétrica, cometido pela obstetra que assistia ao parto. Este relato foi realizado a partir da observação da rotina de uma sala de parto em um hospital de médio porte, por uma acadêmica de enfermagem, durante o estágio curricular obrigatório. Durante o trabalho de parto, a jovem parturiente foi submetida à uma episiotomia sem indicação clínica, contra sua vontade e sem maiores esclarecimentos sobre o procedimento, demonstrando insatisfação com tal ato. A realização rotineira de episiotomia demonstra o despreparo da equipe na assistência ao parto humanizado, evidenciando a necessidade de promover educação continuada.

Full-text (2 Sources)

Download
56 Downloads
Available from
Oct 8, 2014