No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Episiotomy in the United States: Has Anything Changed?
... 82 According to these findings, there was a sharp decline in the use of episiotomy in the United States from 60.9% in 1979 to 9.4% in 2011. 83,84 This reduction was also observed with forceps-assisted births, where episiotomy use declined by 72%, whereas it increased by 37% with vacuum-assisted births 83 However, the incidence of OASI following assisted vaginal birth increased from 7.7% in 1979 to 15.3% in 2004. 83 Although the use of episiotomy declined in this time period, the rise in OASI incidence may have been because of a number of additional factors. ...
... 82 According to these findings, there was a sharp decline in the use of episiotomy in the United States from 60.9% in 1979 to 9.4% in 2011. 83,84 This reduction was also observed with forceps-assisted births, where episiotomy use declined by 72%, whereas it increased by 37% with vacuum-assisted births 83 However, the incidence of OASI following assisted vaginal birth increased from 7.7% in 1979 to 15.3% in 2004. 83 Although the use of episiotomy declined in this time period, the rise in OASI incidence may have been because of a number of additional factors. ...
... 83,84 This reduction was also observed with forceps-assisted births, where episiotomy use declined by 72%, whereas it increased by 37% with vacuum-assisted births 83 However, the incidence of OASI following assisted vaginal birth increased from 7.7% in 1979 to 15.3% in 2004. 83 Although the use of episiotomy declined in this time period, the rise in OASI incidence may have been because of a number of additional factors. With regard to assisted vaginal births, 3 meta-analyses evaluated the effect of mediolateral and lateral episiotomy on OASI incidence. ...
Perineal trauma after vaginal birth is common, with approximately 9 of 10 women being affected. Second-degree perineal tears are twice as likely to occur in primiparous births, with a incidence of 40%. The incidence of obstetrical anal sphincter injury is approximately 3%, with a significantly higher rate in primiparous than in multiparous women (6% vs 2%). Obstetrical anal sphincter injury is a significant risk factor for the development of anal incontinence, with approximately 10% of women developing symptoms within a year following vaginal birth. Obstetrical anal sphincter injuries have significant medicolegal implications and contribute greatly to healthcare costs. For example, in 2013 and 2014, the economic burden of obstetrical anal sphincter injuries in the United Kingdom ranged between £3.7 million (with assisted vaginal birth) and £9.8 million (with spontaneous vaginal birth). In the United States, complications associated with trauma to the perineum incurred costs of approximately $83 million between 2007 and 2011. It is therefore crucial to focus on improvements in clinical care to reduce this risk and minimize the development of perineal trauma, particularly obstetrical anal sphincter injuries. Identification of risk factors allows modification of obstetrical practice with the aim of reducing the rate of perineal trauma and its attendant associated morbidity. Risk factors associated with second-degree perineal trauma include increased fetal birthweight, operative vaginal birth, prolonged second stage of labor, maternal birth position, and advanced maternal age. With obstetrical anal sphincter injury, risk factors include induction of labor, augmentation of labor, epidural, increased fetal birthweight, fetal malposition (occiput posterior), midline episiotomy, operative vaginal birth, Asian ethnicity, and primiparity. Obstetrical practice can be modified both antenatally and intrapartum. The evidence suggests that in the antenatal period, perineal massage can be commenced in the third trimester of pregnancy to increase muscle elasticity and allow stretching of the perineum during birth, thereby reducing the risk of tearing or need for episiotomy. With regard to the intrapartum period, there is a growing body of evidence from the United Kingdom, Norway, and Denmark suggesting that the implementation of quality improvement initiatives including the training of clinicians in manual perineal protection and mediolateral episiotomy can reduce the incidence of obstetrical anal sphincter injury. With episiotomy, the International Federation of Gynecology and Obstetrics recommends restrictive rather than routine use of episiotomy. This is particularly the case with unassisted vaginal births. However, there is a role for episiotomy, specifically mediolateral or lateral, with assisted vaginal births. This is specifically the case with nulliparous vacuum and forceps births, given that the use of mediolateral or lateral episiotomy has been shown to significantly reduce the incidence of obstetrical anal sphincter injury in these groups by 43% and 68%, respectively. However, the complications associated with episiotomy including perineal pain, dyspareunia, and sexual dysfunction should be acknowledged. Despite considerable research, interventions for reducing the risk of perineal trauma remain a subject of controversy. In this review article, we present the available data on the prevention of perineal trauma by describing the risk factors associated with perineal trauma and interventions that can be implemented to prevent perineal trauma, in particular obstetrical anal sphincter injury.
... Episiotomy is a surgical incision in the perineum, performed during the second stage of labor [1]. It was first described in 1742 and has become a common means of preventing maternal injury and improving neonatal outcome [2]. ...
... In recent years, however, there has been no credible evidence to support the routine use of episiotomy; on the contrary, some studies have found significant associated risks [2]. Reported complications include; infection, hemorrhage and hematoma, skin tags and asymmetry, accidental extension to the anal sphincter leading to fecal incontinence, and rectovaginal fistulas. ...
... Following the publicity of such evidence, in 1999, the Cochrane Database Systematic Reviews recommended restrictive use of episiotomy [2], in 2006 the American College of Obstetricians and Gynecologists recommended against routine episiotomy [4], and the WHO recommended an episiotomy rate of 10% for all normal deliveries [3]. ...
Objective This study aims to determine the incidence of episiotomy in Kasr Alainy OBGYN Hospital in Cairo, Egypt. Objectives include identifying factors influencing the incidence of episiotomy. Design This cross-sectional study was conducted between March 1, 2022 and June 30, 2022, to determine the incidence of episiotomy among vaginal deliveries in the hospital. Setting Data was collected from patient charts at Kasr Alainy OBGYN Hospital in Cairo, Egypt. Patient Sample The total number of patient charts inspected was 1731, of which 1545 met the inclusion criteria. Methods Data was manually collected from patient hospital records at the end of each day, and entered into a standardized data-collection form. The data collected was then statistically analyzed using SPSS. Main Outcome Measures The overall incidence of episiotomy was found to be 64%. Results The overall incidence of 64%, broken-down by gravidity, it was found that the incidence of episiotomy is 97% in primigravid patients, and 52% in multigravida patients. Several other associated factors were reviewed. Conclusions The incidence of episiotomy at Kasr Alainy OBGYN Hospital is greater than the WHO recommended rate. Further research is recommended to study the indications of episiotomy and collect information regarding how episiotomy affects patients’ perineal health and quality of life. This will aid in drawing evidence-based conclusions regarding the advantages and drawbacks of episiotomy, and how its incidence changes over time. Funding This research received no external funding. Keywords episiotomy; vaginal delivery; Egypt; Middle East; Africa; gravidity; maternal age; gestational age; cervical diameter; gestational weight
... It is indicated that routinely administered episiotomy causes postpartum early perineal complications and higher perineal pain scores (11)(12)(13), urinary inconsistencey is higher in the postpartum 3 rd month in women undergoing episiotomy (13), and the amount of blood loss is higher in the delivery (14). In another study, it was stated that with a decrease of episiotomy administration, anal sphincter lacerations decreased in vaginal deliveries (15). ...
... In some countries, the episiotomy rate has decreased over the years. The episiotomy rate was 60.9% in all vaginal deliveries in 1979 in the United States of America, but the rate decreased to 24.5% in 2004; (15) in a study conducted in Thomas Jefferson University Hospital, the episiotomy rate decreased from 69.6% in 1983 to 19.4% in 2000 (29), and in a study conducted in Hong Kong, the rate decreased from 73% in 2003 to 27% in 2008 (30). However, the ideal rate of episiotomy is still not clear (15). ...
... The episiotomy rate was 60.9% in all vaginal deliveries in 1979 in the United States of America, but the rate decreased to 24.5% in 2004; (15) in a study conducted in Thomas Jefferson University Hospital, the episiotomy rate decreased from 69.6% in 1983 to 19.4% in 2000 (29), and in a study conducted in Hong Kong, the rate decreased from 73% in 2003 to 27% in 2008 (30). However, the ideal rate of episiotomy is still not clear (15). There are differences between episiotomy rates depending on the countries. ...
Objective:
This study was performed to determine the rate of episiotomy.
Material and methods:
This retrospective was conducted in 3 state hospitals located in 3 cities in the Central Anatolia region of Turkey. Ethics committee approval was received for this study. Also, institutional permissions from the institutions where the study was conducted were obtained before the study. The sample of the study consisted of 8587 women. The data of the study were collected by analyzing birth records in archive records.
Results:
The average age of the women was 26.16±5.9 years, the average number of deliveries was 2.19±1.2, and 52.0% of the women who gave birth via vaginal delivery underwent episiotomy. The rate of episiotomy was found to be 93.3% in primipara women and 30.2% in multipara women. It was determined that neonatal weight did not affect the episiotomy rate, and that neonatal height was higher in deliveries with episiotomy and suture. Also, it was determined that as the age and parity of the women decreased, the rate of episiotomy increased.
Conclusion:
The rate of episiotomy was observed to be high, especially in primipara women.
... En la actualidad aún no se ha llegado a un consenso sobre la tasa ideal de episiotomías que debería establecerse como objetivo 13 . Algunos autores afirman que una tasa del 20% podría ser apropiada, mientras que otros sugieren que podría llegar hasta un 10% en gestantes primíparas y un 5% en multíparas 4 . ...
... Pasar de una política de episiotomía sistemática a otra restrictiva requiere que los profesionales venzan sus temores y se impliquen en aplicar cuidados eficaces, además de un aprendizaje y una mayor confianza en el propio cuerpo de las mujeres 2,36 . La bibliografía revela que las actitudes y las prácticas de los profesionales sanitarios han empezado a cambiar para reflejar las recomendaciones basadas en la evidencia 13 . Como perspectiva de futuro se contempla aumentar tanto la seguridad como el bienestar materno durante el parto, favorecer posiciones alternativas durante el expulsivo y establecer un documento de consenso en nuestro paritorio sobre las indicaciones de la episiotomía. ...
Objective: To analyze the factors that condition the performance of an
episiotomy in spontaneous vaginal deliveries at La Ribera University
Hospital (HULR).
Material and method: A descriptive, cross-sectional and retrospective
study was carried out. Data about spontaneous vaginal deliveries attended
during 2015 were collected. Data were tabulated in Excel
spreadsheet and analyzed with SPSS 17.0 statistical package.
Results: Data from 1,116 spontaneous vaginal deliveries were analyzed
(62% of the total). In 83% of these cases no episiotomy was performed.
A statistically significant relationship was found between the
performance of episiotomy and the variables: primiparity, use of epidural
analgesia, stimulated/induced labour and lithotomy position. There was
no statistically significant relationship to maternal age, weight of the
new-born, health care professional, or perineal trauma appearance.
Conclusions: Knowing the factors that are associated with the performance
of episiotomy in our delivery room is determinant to restrict its
use to those situations strictly necessary. The following measures have
been proposed: the use of alternative positions during the second stage
of labour, spontaneous onset of labour when possible, to respect the
duration of second stage of labour in cases of epidural analgesia, and
the elaboration of a consensus document on episiotomy indications.
... While establishing ideal rates of childbirth interventions is a challenge, [20,21], high rates of interventions should be avoided, especially among low-risk women, because of the risk of adverse effects. ...
... However, CS rates higher than ten 191 percent are not associated with lower maternal and perinatal mortality, [17,18]. In contrast to the increase 192 of CS rates, the episiotomy rate has declined in many countries since the 1980s, [8,19,20]. The World 193 ...
... In contrast, mediolateral episiotomy did not exhibit a similar risk increase and was neither protective nor linked to heightened risk [19]. Considering the growing skepticism regarding its proven efficacy, there has been a notable downward trend in the application of episiotomy in various delivery rooms around the world in recent years [20,21]. The World Health Organization's 2018 guideline acknowledges the difficulty in specifying an "acceptable" episiotomy rate and notes that the procedure's role in critical obstetric situations, like instrumental deliveries for fetal distress, remains undetermined [22]. ...
Objectives
Obstetric anal sphincter injuries (OASIS) pose significant challenges for young women following childbirth. The association between mediolateral episiotomy and OASIS remains a subject of debate and uncertainty. This study seeks to fill this gap.
Methods
This retrospective cohort study was performed using electronic database of obstetrics department at a tertiary medical center. All vaginal deliveries and vacuum-assisted deliveries at term, with a singleton live fetus at cephalic presentation between 2015 and 2021, were included. A comparison of the rates of mediolateral episiotomy and OASIS was conducted between the periods 2015–2017 and 2018–2021. Subgroup analysis was carried out based on parity and the mode of delivery.
Results
Overall, the study included 18,202 women. Between 2015 and 2017, episiotomy was performed in 1,272 cases (17.5 %), compared to 1,241 cases (11.4 %) between 2018 and 2021 (p<0.0001). Conversely, a significant increase in OASIS was observed, rising from 0.3 % during 2015–2017 to 0.6 % during 2018–2021 (p=0.012). Multivariable analysis unveiled two factors significantly linked to OASIS: the temporal cohort studied, indicating an increasing trend in recent years, and the utilization of epidural analgesia, which exhibited a protective effect, while episiotomy was not associated with OASIS.
Conclusions
Our findings indicate a marked decline in the utilization of episiotomy over the study period, accompanied by an increase in OASIS incidence. Nevertheless, our analysis found no statistically significant link between episiotomy use and OASIS incidence.
... Episiotomy-the surgical incision of the perineum to enlarge the vaginal outlet at the time of fetal delivery-was once the most common surgical procedure in obstetrics. In 1979, two-thirds of all vaginal deliveries in the United States involved an episiotomy [1,2]. The theoretical benefits-including prevention of severe perineal injury, faster second stage of labor, and prevention of shoulder dystocia-also led to its routine use in lowand middle-income countries (LMICs) where obstructed labor is a major cause of morbidity and mortality [3][4][5][6]. ...
Background
Findings from research and recommendations from the World Health Organization favor restrictive use of episiotomy, but whether this guidance is being followed in India, and factors associated with its use, are not known. This study sought to document trends in use of episiotomy over a five-year period (2014–2018); to examine its relationship to maternal, pregnancy, and health-system characteristics; and to investigate its association with other obstetric interventions.
Methods
We conducted a secondary analysis of data collected by the Maternal Newborn Health Registry, a prospective population-based pregnancy registry established in Central India (Nagpur, Eastern Maharashtra). We examined type of birth and use of episiotomy in vaginal deliveries from 2014 to 2018, as well as maternal and birth characteristics, health systems factors, and concurrent obstetric interventions associations with its use with multivariable Poisson regression models.
Results
During the five-year interval, the rate of episiotomy in vaginal birth rose from 13 to 31% despite a decline in assisted vaginal birth. Associations with episiotomy were found for the following factors: prior birth, multiple gestations, seven or more years of maternal education, higher gestational age, higher birthweight, delivery by an obstetrician (as compared to midwife or general physician), and birth in hospital (as compared to clinic or health center). After adjusting for these factors, year over year rise in episiotomy was significant with an adjusted incidence rate ratio (AIRR) of 1.10 [95% confidence interval (CI) 1.08–1.12; p = 0.002]. We found an association between episiotomy and several other obstetric interventions, with the strongest relationship for maternal treatment with antibiotics (AIRR 4.23, 95% CI 3.12–5.73; p = 0.001).
Conclusions
Episiotomy in this population-based sample from central India steadily rose from 2014 to 2018. This increase over time was observed even after adjusting for patient characteristics, obstetric risk factors, and health system features, such as specialty of the birthing provider. Our findings have important implications for maternal-child health and respectful maternity care given that most women prefer to avoid episiotomy; they also highlight a potential target for antibiotic stewardship as part of global efforts to combat antimicrobial resistance.
Trial Registration
The study was registered at ClinicalTrials.gov under reference number NCT01073475.
... In the Cochrane meta-analysis published in 2000, these ideas were found to be inaccurate and a 'selective' episiotomy was recommended instead of routine episiotomy (3). After this meta-analysis, episiotomy rates have decreased in many countries (4)(5)(6). It is recommended that the rate of episiotomy should not exceed 10% in vaginal deliveries (7). ...
... Despite the controversy regarding the validity of episiotomy's routine use in obstetrics and the fact that liberal use of the procedure has been discouraged, this is still one of the most commonly performed obstetric procedures worldwide [17,18]. Although this restrictive episiotomy practice has shown many benefits, especially regarding the reduction of injuries to the posterior perineum, the strictest definition of restrictive use was to avoid episiotomy unless indicated for fetal well-being. ...
Episiotomy is one of the most commonly practiced obstetric procedures done to enlarge the diameter of the vulval outlet to facilitate the passage for the fetal head and prevent an uncontrolled tear of the perineal tissues in the second stage of labor. Historically, the procedure was indicated to prevent third- or fourth-degree perineal tears as well as for prolonged second stage, macrosomia, non-reassuring fetal heart rate, instrumental delivery, occiput posterior position, and shoulder dystocia. Routine episiotomy is now considered to be obstetrics violence, rates of not exceeding 10% have been recommended by World Health Organization (WHO). Despite this recommendation, episiotomy is still practiced routinely in many settings.
... In line with this trend, the prevalence of episiotomy decreased from 60.9% to 24.5% in the United States between 1979 and 2004. (4). The prevalence of episiotomy varies from 9.7% in Sweden to about 100% in Taiwan (5). ...
Introduction: Episiotomy is an incision in the perineal area during the second stage of labor to facilitate delivery. Complications of perineal injuries are one of the most important health issues. Oak pair has long been used experimentally to heal wounds and reduce pain. The present study was performed to investigate the effect of oak pair (Quercus infectoria) cream on pain due to episiotomy in nulliparous women. Methods: This double-blind clinical trial experimental study was performed on 120 nulliparous women in Asali hospital in 2018. Individuals were randomly divided into oak pair cream, placebo, and normal saline groups. Data were collected by demographic and midwifery information questionnaires and numerical pain scales. The creams were used by the participants every 12 hours for 10 days, and the pain intensity was evaluated before the intervention and on days 1, 5, and 10. Data analysis was performed by SPSS using chi-square, Kruskal-Wallis, and one-way analysis of variance (ANOVA) tests. Results: There was no statistically significant difference in pain intensity scores among the three groups of oak pair, placebo, and normal saline before the intervention (P= 0.20). Pain intensity on days 1, 5, and 10 after the intervention showed a significant difference between the three groups in favor of oak cream (P< 0.001). The results showed that there was a significant decrease in the mean pain intensity score of the oak pair receiving group over time (P< 0.001). Conclusion: Oak cream might be effective in reducing pain caused by episiotomy due to analgesic properties.
... The prevalence of episiotomy in Mexico ranges from 41.8% in the state of Oaxaca to 77.2% in Mexico Citywhere up to 95% of primiparous women receive an episiotomy [14]; these data seem to reflect the routine practice of episiotomy despite 'knowing' about the complications [15,16]. These figures are much higher when we compare them to the prevalence of episiotomy in the United States (25%) and Europe (30%) [17]. ...
Background
Episiotomy in Mexico is highly prevalent and often routine - performed in up to 95% of births to primiparous women. The WHO suggests that episiotomy be used in selective cases, with an expected prevalence of 15%. Training programs to date have been unsuccessful in changing this practice. This research aims to understand how and why this practice persists despite shifts in knowledge and attitudes facilitated by the implementation of an obstetric training program.
Methods
This is a descriptive and interpretative qualitative study. We conducted 53 pre and post-intervention (PRONTO© Program) semi-structured interviews with general physician, gynecologists and nurses ( N = 32, 56% women). Thematic analysis was carried out using Atlas-ti© software to iteratively organize codes. Through interpretive triangulation, the team found theoretical saturation and explanatory depth on key analytical categories.
Results
Themes fell into five major themes surrounding their perceptions of episiotomy: as a preventive measure, as a procedure that resolves problems in the moment, as a practice that gives the clinician control, as a risky practice, and the role of social norms in practicing it. Results show contradictory discourses among professionals. Despite the growing support for the selective use of episiotomy, it remains positively perceived as an effective prophylaxis for the complications of childbirth while maintaining control in the hands of health care providers.
Conclusions
Perceptions of episiotomy shed light on how and why routine episiotomy persists, and provides insight into the multi-faceted approaches that will be required to affect this harmful obstetrical practice.
... This might be due to the previous studies used smaller sample sizes (381, 338 and 310) were study participants respectively. The result of this study also higher than those studies found at King Abdulaziz university hospital in Saudi Arabia and in the United States the proportion of episiotomy were (35%, 24.5%) respectively [67,68]. This difference might be due to health workers skill gap (gap for skill training) and country policies towards the selective use of episiotomy. ...
Background
Episiotomy is a surgical incision of the perineum to hasten the delivery. There is a scarce of information related to episiotomy practice, and its associated factors, in developing countries, including Ethiopia. Thus, this study was aimed to determine the level of episiotomy practice and to identify its determinants at public health facilities of Metema district, northwest, Ethiopia.
Methods
Institutional-based cross sectional study was conducted among 410 delivered mothers from March 1 to April 30, 2020. We recruited study participants using systematic random sampling technique. Data were entered to Epi data version 3.1 and exported to STATA version 14 for statistical analysis. Stepwise backward elimination was applied for variable selection and model fitness was checked using Hosmer and Lemshows statistics test. Adjusted odds ratio with the corresponding 95% confidence interval was used to declare the significance of variables.
Results
In this study, the magnitude of episiotomy practice was found 44.15% (95% CI 39.32–48.97). Vaginal instrumental delivery (AOR 3.04, 95% CI 1.36–6.78), perineal tear (AOR 3.56, 95% CI 1.68–7.55), age between 25 and 35 (AOR 0.11, 95% CI 0.05–0.25), birth spacing less than 2 years (AOR 4.76, 95% CI 2.31–9.83) and use of oxytocin (AOR 2.73, 95% CI 1.19–6.25) were factors significantly associated with episiotomy practice.
Conclusions
Magnitude of episiotomy practice in this study is higher than the recommended value of World Health Organization (WHO). Instrumental delivery, age, oxytocin, birth spacing and perineal tear were significant factors for episiotomy practice. Thus, specific interventions should be designed to reduce the rate of episiotomy practice.
Plain English summary
The routine use of episiotomy practice is not recommended by WHO. A study that compares routine episiotomy with restrictive episiotomy suggests that the latter is associated with less posterior perineal trauma, less need for suturing, and fewer complications related to healing. In addition, though, the rate of episiotomy has been declined in developed countries, still it remains high in less industrialized countries.
The data for this study were taken at public health facilities of Metema district, northwest, Ethiopia. We included a total of 410 delivered mothers. The magnitude of episiotomy practice was found 44%. This result was higher than the recommended value of WHO. The WHO recommends an episiotomy rate of 10% for all normal deliveries.
The result of this study showed that episiotomy practice is common among mothers whose age group are 18–24. In addition, mothers whose labor were assisted by instrumental vaginal delivery are more likely to have episiotomy as compared to those delivered by normal vaginal delivery. Laboring mothers who had used oxytocin were about three times more likely to be exposed for episiotomy than laboring mothers who did not use oxytocin drug. Moreover, episiotomy practice was nearly five times more likely among mothers who had birth spacing of 2 years and less as compared to mothers who had birth spacing of more than 2 years.
... 13,14 Episiotomy rates decreased from 60.9% in 1979 to 24.5% in 2004, and followed this downward trajectory further to 7.8% in 2017. 15,16 Furthermore, national Finnish data also reflect a concomitant increase in maternal health risk factors. 7 The data indicate that in the 10 years between 2007 and 2017, the average body mass index (BMI) of women before pregnancy marginally increased from 24.2 to 24.8 kg/m 2 . ...
Background: The United States ranks poorly when compared with other developed nations with regard to its maternal mortality ratio (MMR), defined as the number of maternal deaths per 100,000 live births. Meanwhile, Finland consistently ranks as one of the safest places to be pregnant and give birth. The U.S. MMR more than doubled between 1987 and 2016, increasing from 7.2 deaths per 100,000 to 16.9, and has continued to increase. The Finnish MMR in 2017 was reported as 3 deaths per 100,000 live births, compared with the United States' 19 deaths for that same year. This article provides a comprehensive outline of Finland's structure of perinatal care, as well as a review of statistics concerning trends in the country's mortality and morbidity risk factors and a comparison with similar parameters in the United States.
Methods: The Finnish maternal healthcare system was observed through the shadowing of healthcare providers during various pre- and postpartum patient encounters. Further discussion was supplemented by literature review.
Results: Although trends among Finnish mothers for more than the past 30 years indicate increased prevalence of mortality and morbidity risk factors, including C-section rates, maternal mortality remains consistently low. Observational data depict the Finnish perinatal care system as a decentralized community-based network of primary health facilities that emphasizes both physical and psychosocial well-being in the care of its expectant mothers.
Conclusion: We suggest that the Finnish perinatal system of care may provide a good template from which the United States can model future efforts to decrease maternal mortality.
... Epizyotominin yararlarına ilişkin yapılan araştırmalar sonucunda rutin epizyotomi kullanımının etkinliğini açıkça gösteren kanıtlar olmadığı belirlenmiştir. Aksine araştırma sonuçları prolapsus, rekto-vajinal fistül, seksüel disfonksiyon, kan kaybı, hematom, ağrı gibi problemlerin epizyotomiye bağlı olarak ortaya çıktığını göstermiştir (15,53). Woolley epizyotominin kanamayı arttırdığını, anal sfinkter yaralanmalarına neden olabildiğini, intrakranial kanama ve intrapartum asfiksiye ilişkin sonuçları etkilemediğini belirtmiştir (54). ...
ABSTRACT
Perineal trauma is the damage caused by rupture, laceration or episiotomy during birth. Birth-related perineal trauma can lead to many short and long-term physical and psychological morbidities that affect the woman's life. Problems such as pain, bleeding and delay in the attachment of mother and newborn appear in the early postpartum period. In the following period problems such as prolapse, incontinence, sexual dysfunction and anxiety may be experienced. In order to reduce perineal traumas, there are many evidence-based applications in the literature such as perineal massage, warm application to the perineum, birth positions, hand maneuvers and strain techniques. Midwives and nurses are health professionals who have an important role in reducing perineal traumas and performing these evidence-based practices. In this article, approaches to reduce birth related perineal trauma are evaluated.
... Second, among all of the factors available in the PMSI database for non-operative vaginal deliveries, we focused on the variables associated with episiotomy that were major risk factors according to the scientific literature. This includes multiple pregnancies, breech vaginal deliveries, epidural analgesia, NRFHR, and newborn weight > 4,000 g 7,20,[23][24][25][26]49 . In this study, the results obtained in both regression models once again underline that NRFHR, epidural analgesia, and newborn weight > 4,000 g are factors associated with episiotomy for nulliparous deliveries. ...
Episiotomy use has decreased due to the lack of evidence on its protective effects from maternal obstetric anal sphincter injuries. Indications for episiotomy vary considerably and there are a great variety of factors associated with its use. The aim of this article is to describe the episiotomy rate in France between 2013 and 2017 and the factors associated with its use in non-operative vaginal deliveries. In this retrospective population-based cohort study, we included vaginal deliveries performed in French hospitals (N = 584) and for which parity was coded. The variable of interest was the rate of episiotomy, particularly for non-operative vaginal deliveries. Trends in the episiotomy rates were studied using the Cochran-Armitage test. Hierarchical logistic regression was used to identify variables associated with episiotomy according to maternal age and parity. Between 2013 and 2017, French episiotomy rates fell from 21.6 to 14.3% for all vaginal deliveries (p < 0.01), and from 15.5 to 9.3% (p < 0.01) for all non-operative vaginal deliveries. Among non-operative vaginal deliveries, epidural analgesia, non-reassuring fetal heart rate, meconium in the amniotic fluid, shoulder dystocia, and newborn weight (≥ 4,000 g) were risk factors for episiotomy, both for nulliparous and multiparous women. On the contrary, prematurity reduced the risk of its use. For nulliparous women, breech presentation was also a risk factor for episiotomy, and for multiparous women, scarred uterus and multiple pregnancies were risk factors. In France, despite a reduction in episiotomy use over the last few years, the factors associated with episiotomy have not changed and are similar to the literature. This suggests that the decrease in episiotomies in France is an overall tendency which is probably related to improved care strategies that have been relayed by hospital teams and perinatal networks.
... In 2006, the American College of Obstetricians and Gynecologists (ACOG) discouraged the practice of routine episiotomy with all vaginal births [5]. Consequently, the rate of episiotomy in the USA decreased from 60.9% in 1979 to 24.5% in 2004 [6], and by 2012, the episiotomy rate had reached 11-12% [7]. Nevertheless, episiotomy rates tend to increase in developing countries, for example, the rate ranges from 39.3 to 85.1% in India [8]. ...
Introduction and hypothesisA variety of pharmacological and non-pharmacological interventions have been investigated, with the goal of relieving pain after post-episiotomy repair. We aimed to compare the efficacy of tramadol versus celecoxib orally in reducing pain after mediolateral episiotomy repair in obese primigravidae undergoing spontaneous vaginal delivery.Methods
We conducted a randomized double-blinded trial in Cairo University hospital, Cairo, Egypt, from October 2018 to December 2019. We randomly assigned 200 women into two groups: group A (n = 100) received one tramadol tablet 100 mg orally whereas group B (n = 100) received one celecoxib tablet 200 mg orally. Our primary outcome was pain score using a 10-cm visual analog scale at different time intervals. Our secondary outcomes were the overall satisfaction score and drug side effects.ResultsAfter mediolateral episiotomy repair, the pain scores at 1, 2, and 4 h were significantly lower in the tramadol group than in the celecoxib group (p < 0.001). However, there were no significantly differences in pain scores at 8 and 12 h between the two groups (p = 0.50 and 0.48 respectively). Women’s satisfaction score was significantly higher in the tramadol group than in the celecoxib group (p < 0.001). Fewer participants in the tramadol group needed additional analgesics than in the celecoxib group; however, the difference was not significant (p = 0.17). Drug adverse effects were comparable in the two groups.Conclusions
Primigravid women who received tramadol 100 mg orally after mediolateral episiotomy repair had lower pain scores and were more satisfied than women who received celecoxib 200 mg orally. Both drugs were well tolerated, with few side effects.
... But in most of abovementioned countries it is used selectively. For example, its reported rate in a national survey in the US was 25% in 2004 [43] and in a recent study in two largest maternity public hospitals in Greece was 17% [44]. Similar with Iran, episiotomy rate in Turkey is also high (93% in primiparous and 30% in multiparous women) [45]. ...
Background:
Maternal childbirth dissatisfaction has short- and long-term negative effects on the mothers' health and life, as well as on relation with her child and family. Due to lack of studies in Iran and other counties, we aimed to determine pre- and during- labour predictors of low birth satisfaction.
Methods:
Seven hundred women with low risk singleton pregnancy participated in this prospective analytical study. The participants were hospitalized for vaginal delivery with fetus in cephalic presentation and gestational age of 370-416 at two teaching centers in Tabriz (Iran). Woman characteristics, anxiety state (using Spielberger inventory) and dehydration were assessed at cervical dilatation of 4-6 cm. Iranian (Persian) birth satisfaction scale-revised was applied 12-24 h after birth. Multiple linear regression was used to determine the predictors.
Results:
Excluding 26 women who were outliers, 674 women were analyzed. The mean birth satisfaction score was 23.8 (SD 6.5) from an attainable score of 0-40. The during-labour predictors of low birth satisfaction score were severe and moderate anxiety, labour dystocia, insufficient support by staff, vaginal birth with episiotomy and tear, emergency cesarean section, labour induction and labour augmentation with oxytocin, and woman dehydration. The pre-labour predictors included being primiparous, sexual and emotional violence during pregnancy, gestational age of 400-416, preference for cesarean section, no attendance at pregnancy classes, and insufficient household income. The proportion of the variance explained by the during-labour variables was 75%, by pre-labour variables was 14% and by overall was 76%.
Conclusions:
The controllable during-labour predictors explains most of the variance of the satisfaction score. It seems that responding to women's physical and psychological needs during labour and applying less interventions could improve women's childbirth satisfaction.
... To prevent unnecessary perineal surgical incision, countries are following restricted episiotomy practice and reducing the episiotomy rate. One of such evidence is a study conducted in the United States that shows a decline of episiotomy rate from 60.9% in 1979 to 24.5% in 2004 [21]. There is also a study that indicate the possibility of a zero percent episiotomy with a high frequency of intact perineum, reduced need for suturing, and no adverse outcomes such as severe perineal lacerations [22]. ...
Background: Episiotomy is a surgical incision of the perineum during delivery to enlarge the vaginal orifice. It is one of the most commonly performed obstetric intervention world widely. The magnitude of episiotomy varies from population to population. Limited information exists related to the practice of episiotomy in Ethiopia. This study aimed to assess the prevalence of episiotomy and its associated factors in University of Gondar Comprehensive Specialized Referral Hospital, Ethiopia. Methods: Institution based retrospective cross-sectional study was undertaken from March to June 2014 on 306 mothers who had a vaginal delivery in the Hospital. Systematic random sampling technique was employed to select study units. The data were collected using pretested cheek list. Proportion of patients who had episiotomy was calculated and the association between dependent and independent variables was checked using both binary and multiple logistic regression and Chi-square. Results: Prevalence of episiotomy in University of Gondar Comprehensive specialized Referral Hospital was 47.7% (n = 146). Majority (89.5%) of the delivery was spontaneous vaginal delivery while vacuum, forceps and destructive delivery were 4.6%, 4.6%, and 1.3% respectively. During pregnancy and delivery, 84% of mothers had no associated diseases while 8% had hypertensive disorder, 5% diabetes mellitus and 3% of them has other diseases. After multivariate analysis episiotomy was significantly associated with maternal age (15-24 years) (p = 0.041, AOR (CI 95%) 1.65 (1.02-2.66)), primiparity (p =0.010, AOR (CI 95%) 2.61 (1.54-4.44)), prolonged labor (p = 0.001, COR (CI 95%) 6.45 (2.89-14.38)), and weight of newborn (p = 0.044, COR (CI 95%) 2.48 (1.16, 5.31)). Conclusion: Prevalence of episiotomies in the institution was 47.7% and variables that remained associated significantly with episiotomy were maternal age, primiparity, prolonged labor, and newborn weight.
... To prevent unnecessary perineal surgical incision, countries are following restricted episiotomy practice and reducing the episiotomy rate. One of such evidence is a study conducted in the United States that shows a decline of episiotomy rate from 60.9% in 1979 to 24.5% in 2004 [21]. There is also a study that indicate the possibility of a zero percent episiotomy with a high frequency of intact perineum, reduced need for suturing, and no adverse outcomes such as severe perineal lacerations [22]. ...
... 5 Stakeholder professional association recommendations for restrictive use led to a decrease in the rate of episiotomy with all vaginal births in the United States, from 60.9% in 1979 to 24.5% in 2004. 6 The rate continued to drop to 11.6% in 2012 based on information from an all-payer database of 510 hospitals, which reflects the latest available US data. 7 When comparing 10% of hospitals that used the procedure the most frequently with 10% of hospitals that used it the least frequently, the rate was 34.1% (95% CI, 32.0%-36.3%) ...
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.
... This recommendation has greatly reduced the rates of episiotomy application in obstetrics practice from 80 % to about 18-25% in Western countries. From the reviewed obstetrics records in one of the largest hospitals in the US, the rates of episiotomy reduced from 60.9 % in the year 1979 to 24.5 % by the year 2004 [1,41]. Similarly, in Victoria (Australia) obstetrics records from the year 2005 to 2006 confirms that the application rates of episiotomy have reduced significantly to about10-18 % of all the normal vaginal deliveries in both public and private hospitals [42]. ...
... 17 The more severe lacerations are relatively less common, as a review of literature estimated the rate of a grade 3 or 4 tear at approximately 11%. 18 In the United States, the trend has been to decrease episiotomy rates from over 60% in the 1980s down to 24.5% in 2004 19 and now closer to 11.6% in 2012 20 given the evidence against routine utilization of episiotomy. 21 Interestingly, it seems that as the rates of episiotomy have declined, there has been some increase in the rate of low-grade perineal tears (increasing from 133,000 in 1980 to 882,000 by 1998), 22 which makes sense because many of the women who would naturally suffer a low-grade tear would previously be treated with an episiotomy. ...
Background
A significant proportion of patients seeking labiaplasty are nulliparous and may experience later changes to their labia following vaginal delivery.
Objectives
In the present study, we report the long-term outcomes of a single surgeon’s patient cohort who had vaginal delivery after labiaplasty.
Methods
A retrospective chart review of the senior author’s database was conducted. All patients undergoing in-office labiaplasty from 2007-2018 were surveyed. The resulting cohort was stratified into patients who had delivered children prior to labiaplasty, and those that delivered after labiaplasty.
Results
204 patients responded to a phone survey. 70 patients had children prior to undergoing labiaplasty, while 33 had children after labiaplasty. The rate of vaginal delivery was lower in the women who had children before labiaplasty (82.6% vs. 91.8%, p = 0.015). The tear/episiotomy rate for vaginal deliveries was lower in women who had children prior to labiaplasty compared to after labiaplasty (3.1% vs. 17.8%, p < 0.001). Among the women who had children only after labiaplasty, the reported tear/episiotomy rate was 7/39 vaginal deliveries (17.9%).
Conclusion
Patients in our cohort had over 90% success with vaginal deliveries after labiaplasty. For nulliparous patients contemplating the procedure, the data we present suggest the risk of episiotomy or vaginal tear risk with vaginal birth after labiaplasty is comparable to or lower than the general population, further supporting the safety of this procedure. For patients with prior delivery, the data are more limited but suggest no increased risk in this small cohort.
... Episiotomy rates around the country declined from $ 94% in 2000 8 to 76% in 2006 9 and 54% in 2014. 10 Nevertheless, this rate is still high, mainly when compared with other countries such as the United States (24.5%), 11 France (13.3%) 12 and the Netherlands (10.8%). 13 Various interventions have been proposed in an attempt to reduce episiotomy rates. ...
Objective To determine the prevalence of episiotomy and the factors associated with the knowledge, attitude and practice (KAP) of Brazilian obstetricians in relation to this procedure.
Methods A KAP survey was conducted with obstetricians working in Brazil. An electronic form containing structured questions previously evaluated using the Delphi method was created in Google Docs and sent by e-mail. A multivariate logistic regression was performed to determine the principal factors associated with adequate KAP. For each dependent variable (knowledge, attitude and practice) coded as adequate (1 = yes; 0 = no), a multiple logistic regression model was developed. Binary codes (1 = yes and 0 = no) were assigned to every independent or predictor variables. Prevalence ratios (PRs) and their respective 95% confidence intervals (95%CIs) were calculated as measures of relative risk, at a significance level of 5%.
Results Out of the 13 thousand physicians contacted, 1,163 replied, and 50 respondents were excluded. The mean episiotomy rate reported was of 42%. Knowledge was determined as adequate in 44.5% of the cases, attitude, in 10.9%, and practice, in 26.8% of the cases.
Conclusion Most respondents had inadequate knowledge, attitudes and practices regarding episiotomy. Although some factors such as age, teaching, working in the public sector and attending congresses improved knowledge, attitude and practice, we must recognize that episiotomy rates remain well above what would be considered ideal. Adequate knowledge is more prevalent than adequate attitude or practice, indicating that improving knowledge is crucial but insufficient to change the outlook of episiotomies in Brazil.
... In this There has been a decline in instrumental delivery in the USA in recent years, with a rate of just >3% in 2013 [26]. Similarly, the downward trend in the USA had also been observed in episiotomy rates with instrumental vaginal delivery [27]. ...
Introduction and hypothesisWe hypothesized whether a non-episiotomy protocol or administration of selective episiotomy as an intrapartum intervention would modify the incidence of obstetric anal sphincter injuries (OASIS).Methods
We registered this systematic review with the PROSPERO database (CRD42018111018). Prospective randomized controlled trials (RCTs) were included from databases until February 2019. The primary outcome was OASIS, and the secondary outcomes were any perineal trauma, duration of the second stage of labor, instrumental delivery, and post-partum hemorrhage. The risk of bias (Cochrane Handbook) and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria were used to assess the RCTs.ResultsA total of 1,833 results (PubMed 650, SCOPUS 1,144, Cochrane Library 33, LILACS 6) were obtained. However, only 2 studies fulfilled the criteria for quantitative analysis and meta-analysis (n = 574). The non-episiotomy arm included two episiotomies (1.7% of deliveries), whereas the selective episiotomy included 33 episiotomies (21.4%). Performance of selective episiotomy demonstrated no difference compared with that of the non-episiotomy group with regard to OASIS (OR = 0.46 [0.15–1.39]; n = 543; I2 = 0%,p = 0.17), any perineal trauma (OR = 0.90 [0.61–1.33]; I2 = 0%, n = 546, p = 0.59), instrumental delivery (OR = 1.40 [0.80–2.45]; I2 = 0%, n = 545, p = 0.24), duration of the second stage of labor (MD = -3.71 [−21.56, 14.14]; I2 = 72%,n = 546, p = 0.68), perineal pain (MD = 0.59 [0.01–1.17]; I2 = 0%,p = 0.05), and post-partum hemorrhage (OR = 1.75 [0.87–3.54]; I2 = 0%,n = 546,p = 0.12). The evaluated studies displayed a low risk of bias in at least four of the seven categories analyzed. GRADE demonstrated a low certainty for severe perineal tears, postpartum hemorrhage, duration of the second stage of labor, and a moderate certainty for any perineal tear.Conclusions
There was no significant difference between non-episiotomy and selective episiotomy regarding OASIS. No RCT was able to confirm a benefit of the non-performance of episiotomies in the non-episiotomy arm.
... Sua prática foi introduzida no século XVIII, em 1741, por Ould*, como um meio para prevenir lacerações severas a ser empregado excepcionalmente (1)(2) . No entanto, devido à falta de anestesia e as altas taxas de infecção, popularizou-se no século XX, tendo como principais expoentes, os obstetras De Lee e Pomeroy (3) , sendo sua prática, difundida em vários países, principalmente nos Estados Unidos e países da América Latina, principalmente o Brasil (1) . ...
Objetivo: Estudar a prevalência da episiotomia, associação das complicações perineais maternas quando da sua realização ou não, com características biométricas fetais e características maternas nos partos realizados em uma maternidade de baixo risco. Métodos: Estudo retrospectivo, transversal observacional, analítico, descritivo que avaliou 511 puérperas hígidas, de risco habitual da Maternidade Victor Ferreira do Amaral, que tiveram partos transpélvicos de 01 de janeiro à 30 de abril de 2018, referentes à realização ou não de episiotomia, lacerações, idade, paridade, peso do recém-nascido, Apgar de 1º e 5º minutos e posições do parto. Foram significativas as variáveis com p<0,05. Resultados: A episiotomia foi realizada em 32 (6,26%) das parturientes. No estudo 46 pacientes (9%) eram menores de idade e 298 (58,31%) eram primíparas. Não houve lacerações perineais em 240 partos (46,96%), houve lacerações de 1º grau em 180 partos (35,22%) e lacerações de 2º grau em 91 partos (17,80%). A média do Apgar 1º minuto foi 8 e 5º minuto foi 9. O peso médio ao nascer 3159g. Quanto às posições do parto: 84 (16,43%) foram partos em decúbito dorsal; 218 (42,66%) semi-sentados; 68 (13,30%) banco/ banqueta; 20 (3,91%) quatro apoios; 101 (19,76%) cócoras e 16 (3,13%) decúbito lateral. Correlacionaram-se primiparidade e episiotomia (p<0,001), peso do recém-nascido > 3000g e episiotomia (p=0,024), posição dorsal e episiotomia (p<0.001). Tiveram associação as variáveis primiparidade e lacerações (p<0,001). Correlacionando laceração e posições de parto, houve significância estatística entre laceração e posição dorsal (p=0,0409), posição parto no banco (p<0,001) e posição cócoras (p<0,001). Conclusões: A prevalência da episiotomia foi de 6,26%, considerada satisfatória. O peso fetal relacionou-se diretamente com os índices de lacerações perineais e de realizações de episiotomia. A primiparidade apresentou índices significativamente maiores de episiotomia e de lacerações perineais. As lacerações perineais predominaram significativamente nas posições verticais do parto (cócoras e banco). Enquanto episiotomias predominaram na posição de decúbito dorsal do parto.Descritores: Episiotomia, Lacerações, Períneo/lesões, Paridade, Peso fetalABSTRACT:Objective: To study the prevalence of episiotomy, the association of maternal perineal complications when it is carried out or not, with fetal biometric characteristics and maternal characteristics in deliveries performed at a low risk maternity hospital. Methods: Retrospective, observational, analytical, descriptive cross-sectional study that evaluated 511 healthy puerperal women at the usual risk of Victor Ferreira do Amaral Maternity, who had vaginal deliveries from January 1 to April 30, 2018, regarding episiotomy, lacerations, age, parity, newborn weight, 1st and 5th minute Apgar, and delivery positions. The variables with p <0.05 were significant. Results: Episiotomy was performed in 32 (6.26%) of parturients, 46 (9%) under age, 298 (58.31%) primiparous. There were no perineal lacerations in 240 births (46.96%), 1st degree lacerations in 180 births (35.22%) and 2nd degree lacerations in 91 births (17.80%). The average of the 1st minute Apgar was 8 and the 5th minute was 9. The average birth weight 3159g. Regarding the delivery positions: 84 (16.43%) delivery in the supine position; 218 (42.66%) semi-sitting; 68 (13,30%) bench / banquette; 20 (3.91%) four supports; 101 (19.76%) squatting and 16 (3.13%) lateral decubitus. Primiparity and episiotomy (p <0.001), birth weight> 3000g and episiotomy (p = 0.024), dorsal position and episiotomy (p <0.001) were correlated. The variables primiparity and lacerations were associated (p <0.001). Correlating laceration and delivery positions, there was statistical significance between laceration and dorsal position (p = 0.0409), birthing position in the bench (p <0.001) and squatting position (p <0.001). Conclusions: The prevalence of episiotomy was 6.26%, considered satisfactory. The fetal weight was directly related to the rates of perineal lacerations and episiotomy achievements. Primiparity had significantly higher rates of episiotomy and perineal lacerations. The perineal lacerations predominated significantly in the vertical positions of the childbirth (squatting and in the bench). While the episiotomies predominated in the position of dorsal decubitus of the childbirth.Keywords: Episiotomy, Lacerations, Perineum/injuries, Parity, Fetal weight
... A study performed in the USA with low-risk mothers reported 24.5% of episiotomies. 26 In other studies conducted in Spain in which no distinction is made between women at high or lower risk, varying rates of episiotomies are reported, ranging from 20%, 27 8% 28 and 33.5%, 29 all of which are lower rates to those obtained in our study. The implementation of a policy of selective episiotomies, as recommended by the CPGCNB, should not translate into an increased percentage of third and fourth degree tears. ...
Objective
To determine the percentage of pregnant women who are potential candidates for a normal birth in the region of Cantabria, Spain. Also, to compare the main clinical practice outcome indicators and the rates of maternal and neonatal morbidity among the group of candidate women versus non-candidates.
Design
A cross-sectional study.
Setting
A tertiary Hospital in Cantabria (Northern region of Spain).
Participants
The study population comprised the total number of hospital births that took place between 1 January 2014 and 31 December 2014 (n=3315).
Results
Secondary registers were accessed to review the main indicators of care and the outcome of births. The χ ² test or the Student’s t-test were used to compare both groups for the categorical and continuous variables, respectively. In total, 1863 births (56.20%) were candidates for applying the strategy of care for a normal birth. In 50.86% of these candidate births, an episiotomy was performed, compared with 60.96% in the group of non-candidates (p<0.001). Regarding caesarean sections, these were carried out in 19.32% of the candidate births, compared with 26.79% of non-candidate births (p<0.001). Furthermore, there were statistically significant differences between the groups according to the type of birth, the need for instrumental birthing methods, the existence of perineal tears, Apgar scores and the requirement for the infant to be admitted to the neonatal intensive care unit.
Conclusions
Our results suggest a differential clinical practice, in line with the recommendations of the Clinical Practice Guidelines for Care of Normal Birth. Nonetheless, improvements are necessary regarding the care provided to women and infants, as the percentages of episiotomies and caesarean sections are still high when compared with current standards and compared with other reports.
... Episiotomy is common worldwide, but rates vary from country to country. [11]. These large differences in episiotomy practice rates reflect large differences of opinion as to the usefulness of episiotomy. ...
... Episiotomy may cause bleeding, infection, dyspareunia, and postpartum pain [1] and should not be used routinely but only when indicated [2]. e use of episiotomy has declined markedly from 60% in 1979 to 9.4% in 2011 in the United States [3,4] and from 20% in 1975 to 7% in 2010 in some Scandinavian countries [5,6]. e rate in low-income countries remains relatively high. ...
Episiotomy should be cut at certain internationally set criteria to minimize risk of obstetric anal sphincter injuries (OASIS) and anal incontinence. The aim of this study was to assess the accuracy of cutting right mediolateral episiotomy (RMLE). An institution-based prospective cohort study was undertaken in a Palestinian maternity unit from February 1, to December 31, 2016. Women having vaginal birth at gestational weeks ≥24 or birthweight ≥1000 g and with intended RMLE were eligible ( n=240 ). Transparent plastic films were used to trace sutured episiotomy in relation to the midline within 24-hour postpartum. These were used to measure incisions’ distance from midline, and suture angles were used to classify the incisions into RMLE, lateral, and midline episiotomy groups. Clinical characteristics and association with OASIS were compared between episiotomy groups. A subanalysis by profession (midwife or trainee doctor) was done. Less than 30% were RMLE of which 59% had a suture angle of <40° (equivalent to an incision angle of <60°). There was a trend of higher OASIS rate, but not statistically significant, in the midline (16%, OR: 1.7, CI: 0.61–4.5) and unclassified groups (16.5%, OR: 1.8, CI: 0.8–4.3) than RMLE and lateral groups (10%). No significant differences were observed between episiotomies cut by doctors and midwives. Most of the assessed episiotomies lacked the agreed criteria for RMLE and had less than optimal incision angle which increases risk of severe complications. A well-structured training program on how to cut episiotomy is recommended.
... 2000 yılında yayınlanan Cochrane metaanalizinde bu düşüncelerin yanlış olduğu tespit edilmiş ve rutin epizyotomi yerine "selektif" epizyotomi uygulaması önerilmiştir (3). Bu metaanaliz sonrası dünyanın bir çok ülkesinde epizyotomi oranlarında düşüş yaşanmıştır (4)(5)(6). Vajinal doğumlarda epizyotomi oranının %10'u geçmemesi gerektiği önerilmektedir (7). Epizyotominin postpartum kanamayı artıran risk faktörlerinden olduğu birçok çalışmada tespit edilmiştir (8)(9)(10). ...
... 16 During this time, much has changed in the patterns of birth, including a substantial increase in cesareans and a decrease in episiotomies. 17,18 A recent ecologic study in the United States found a correlation between living in a state that has autonomous certified nurse-midwife practice and having lower rates of cesarean and preterm birth, 19 providing initial support for the role midwives may play in providing care associated with fewer interventions during labor and birth. Potential adverse outcomes that may be associated with less use of interventions experienced by women who receive midwifery care in the United States are not often studied. ...
Introduction
Few studies have compared midwife‐led and physician‐led care in the United States. Our objective was to compare the frequency of birth interventions and maternal and neonatal outcomes between women who received prenatal care from a midwife and those who received care from a physician, among women who were low risk when they initiated prenatal care.
Methods
We performed a retrospective cohort study of women giving birth at a large public hospital who had at least one prenatal visit before 20 weeks’ gestation in the years 2012 through 2015. We classified women according to prenatal care provider type (midwife vs physician) at first prenatal visit and compared birth outcomes between the groups, using intent‐to‐treat analyses. We used modified Poisson regression to calculate adjusted risk ratios (aRRs) for common outcomes and logistic regression with Firth's bias correction to produce adjusted odds ratios (aORs) for rare outcomes. As a sensitivity analysis, we performed a matched propensity score analysis to account for potential confounding by indication.
Results
Midwives provided care to 8.2% of the women; physicians provided care to 91.8% of the women. Women in midwifery care were less likely to be black, have Medicaid insurance, or have a history of pregnancy complications or previous cesarean births compared with women who received care from physicians. Women in midwifery care had lower risks of cesarean (aRR, 0.66; 95% CI, 0.57‐0.78) and preterm birth (aRR, 0.58; 95% CI, 0.42‐0.79), with no increased odds of neonatal intensive care unit admissions, neonatal deaths, or severe maternal morbidity. Women in midwifery care had increased odds of postpartum hemorrhage and shoulder dystocia (aOR, 3.26; 95% CI, 1.40‐7.58, and aOR, 1.80; 95% CI, 1.01‐3.22, respectively); however, these did not remain significant in the propensity score analysis.
Discussion
Among women with low‐risk pregnancies, midwifery care was associated with substantially fewer preterm births and labor interventions.
... This episiotomy rate is lower than in countries of South East Asia, where a study found an overall rate of 65%, ranging from 47% in Malaysia to 91% in Thailand [3]. It is similar to a rate of 25% reported from a study of hospital discharge records in the USA [26]. Routine episiotomy is still practised in some countries in the persisting belief that it prevents severe perineal tears, especially among primiparas [5]. ...
Background:
Episiotomy and perineal tears remain common in vaginal deliveries. This study estimated the frequency of and factors associated with perineal tears, episiotomies, and postnatal infections among women in two predominantly indigenous municipalities in southern Mexico, where traditional midwives play an important role in women's health.
Methods:
A cross-sectional study contacted women who gave birth in the previous three years. An administered questionnaire asked about place of delivery, birthing position, birth attendant, episiotomy, perineal tears, and wound infection after delivery. Cluster adjusted bivariate and then multivariate analysis examined factors potentially associated with self-reported perineal trauma (episiotomy and/or perineal tear). Key informant interviews sought insights into some of the findings.
Results:
Among women with a vaginal delivery, 71% (876/1238) of indigenous women and 18% (36/197) of non-indigenous women delivered at home. Some 17% (247/1416) of women overall, and 33% (171/525) of those delivering in a health facility, reported an episiotomy during delivery. Among 171 women reporting an episiotomy in a health facility, 30% (52) also reported a perineal tear. Overall, 13% (190/1412) of women reported they had a perineal tear during delivery, 17% (86/515) of those delivering in a health facility and 12% (104/897) of those delivering at home. A quarter of the women had self-reported perineal trauma during their last delivery, 38% (196/511) of those delivering in a health facility and 18% (160/893) of those delivering at home. In bivariate analysis, indigenous ethnicity, home delivery, upright posture in labour, and delivery by a traditional midwife were associated with a lower risk of perineal trauma, while primiparas had a higher risk. In the final multivariate model, delivery by a traditional midwife was protective (ORa 0.41, 95%CIca 0.32-0.54) and primiparity was a risk factor (ORa 2.01, 95%CIca 1.5-2.68) for perineal trauma. Women suggested that fear of bad treatment and being cut made them unwilling to deliver in health facilities.
Conclusions:
The rate of perineal trauma among women giving birth in indigenous communities could be reduced by efforts to decrease the use of episiotomies in health facilities, and by opening a dialogue with traditional midwives to increase their interaction with formal health services.
... The episiotomy rate is different in different countries, ranging from 3.7 to 75.0% [1,2]. In USA, the rate of episiotomy with all vaginal deliveries decreased from 60.9% in 1979 to 24.5% in 2004 [3]. Even if one reason for episiotomy is perineal protection from severe lacerations, there is conflicting evidence as to whether mediolateral episiotomy reduces the risk of obstetric anal sphincter injuries (OASI) [1,2,[4][5][6][7][8]. ...
Introduction and hypothesis:
Mediolateral episiotomy is one of the most frequent surgical interventions performed in obstetrics. There is conflicting evidence as to whether mediolateral episiotomy reduces the risk of obstetric anal sphincter injuries (OASI). Recent studies suggest that functional asymmetry of pelvic floor innervation exists in healthy women and is strongly associated with postpartum incontinence when the trauma occurs on the dominant side of innervation. Mediolateral episiotomy is the most common cause of perineal trauma during delivery, and the surgical incision is usually performed on the mediolateral right side. Surface electromyography (EMG) has been recently applied in obstetrics for detecting electrical activity of the external anal sphincter (EAS).
Methods:
Two hundred and forty-five pregnant nulliparous women at their second and third trimester of pregnancy were recruited, and EMG signals were detected using a multichannel cylindric anal probe. Measurements were repeated and compared 6-8 weeks after delivery on a subgroup of 167 women who were divided in two groups according to EMG amplitude asymmetry before delivery and two subgroups according to type of delivery: (1A) asymmetric left, episiotomy right; (1B) asymmetric left, other types of deliveries; (2A) asymmetric right, episiotomy right; (2B) asymmetric right, other type of deliveries.
Results:
The reduction of EMG amplitude after right episiotomy was larger in women with right asymmetric sphincter compared with women with left asymmetry and women with other types of delivery.
Conclusions:
Prenatal EMG may be used to predict the impact of right-sided mediolateral episiotomy on EAS and perhaps also function following delivery.
... In the United States, the rate of performing episiotomy decreased from 60.9% in 1979 to 24.5% in 2004 (Frankman, Wang, Bunker, & Lowder, 2010), but this procedure is widely common in Asian countries due to women's short perineum and firm tissues (Lam, Wong, & Pun, 2006). ...
The delayed healing of episiotomy wound and its associated pain is a major problem in obstetrics. Because green tea has analgesic and wound-healing properties, the present study was conducted to determine the effect of green tea ointment on episiotomy pain and wound-healing. The green tea extract was also standardized by measuring its Phenolic and flavonoid compounds, antioxidant activity, and one of its active components, that is, Epigallocatechin gallate. The present clinical trial was conducted on 99 primiparous women visiting Afzalipour Hospital in Kerman in 2015. The subjects were randomly divided into 3 groups, including a green tea ointment group, a placebo ointment group, and a routine care group. The 2 ointment groups smeared 2 cm of the green tea or placebo ointments onto their sutured area twice daily for a total of 10 days. The severity of pain was assessed in the subjects using the visual pain scale and wound-healing using the Redness, Edema, Ecchymosis, Discharge, Approximation (REEDA) scale before the intervention and on the 5th and 10th days after delivery. To standardize the extract, Epigallocatechin gallate was measured by high-performance liquid chromatography (HPLC). Phenolic and flavonoid compounds, as well as antioxidant activity of the extract were also determined by spectrometry methods. Before the intervention, no significant differences were observed between the 3 groups in terms of their personal and obstetric details (p > .05), the severity of pain (p = .118), and the REEDA score (p = .212). On the 5th and 10th days after delivery, the severity of pain was significantly lower in the green tea group than in the other 2 groups (p < .0001). The mean REEDA score on the 5th and 10th days showed a better and faster healing in the green tea group compared to the other 2 groups (p < .0001). Total content of phenolic and flavonoids contents of green tea were 74.2 mg/g Gallic acid equivalent and 16.3 mg/g Rutin equivalent, respectively, and its antioxidant capacity was 46% of b-carotene. Green tea ointment appears to be effective in relieving episiotomy pain and improving wound-healing in this study. Further studies are recommended to be conducted on the effectiveness and safety of the different doses of green tea ointment.
... Episiotomy is one of the most commonly performed sur- gical procedures during delivery, yet there is extensive disagreement about the necessity and benefits of this pro- cedure. The lack of consensus about routine or restricted use of episiotomy is reflected in the wide variation in the episiotomy rates being reported in different studies. 1 In the United States, changing trends in obstetrical practice influenced the decision to perform an episiotomy and resulted in a decreasing prevalence, from 60.9% in 1979 2 to 12% in 2012, 3 though there was little decline of its use in Nigeria (45%) 4 and France (68% in nulliparae, 31% among multiparae). 5 To evaluate the trends in a tertiary care center in Rajasthan, records of 1,000 primigravida with singleton full-term vaginal deliveries were analyzed retrospectively, which showed that almost all of them were delivered vaginally with liberal use of episiotomy. ...
Aim
There is extensive disagreement about the necessity and benefits of routine episiotomy for all. The American Congress of Obstetricians and Gynecologists Committee on Practice Bulletins, 2006 based on good scientific evidence recommends restricted use of episiotomy to be preferred, yet its restricted use is not being practiced. Keeping these in mind, the study was done with the aim to assess the effects of restrictive use of episiotomy during vaginal birth.
Materials and methods
This was a prospective study. Singleton primigravida term vaginal deliveries over 3 months were included. Under the policy of restricted use of episiotomy, great restraint was observed in giving an episiotomy. Mediolateral episiotomy was given in women where expected baby weight >3 kg or perineal tear was anticipated, and in cases of instrumental deliveries. Perineal tears, postpartum status, and satisfaction level of women were compared between patients with or without episiotomy. Data so obtained were analyzed.
Results
About 29.8% women delivered with episiotomy, 65.5% had intact perineum; 5.67% women had first-degree perineal tear and only 1.42% women had second-degree perineal tear using a policy of restricted use of episiotomy. None of the women had third- and fourth-degree perineal tear. Patients delivered without episiotomy were more comfortable in terms of less perineal pain, early evacuation of bladder, and ambulation.
Conclusion
With the restricted use of episiotomy using precise clinical judgment, the unnecessary episiotomies could be avoided, giving better care and patient satisfaction with minimum maternal morbidity.
Clinical significance
The policy of restricted use of episiotomy would result in considerable reduction in maternal morbidity, decreased hospital stay and overall cost, and good patient satisfaction level.
How to cite this article
Dadhich B, Hooja N, Sharma A, Aseri S, Sharma A, Kumawat B. Restricted Use of Episiotomy. J South Asian Feder Obst Gynae 2017;9(3):260-262.
... Crohn's Disease: Mode of Delivery According to Perianal StatusThe CS rate in the general population is 33% in the USA, 21% in France, 15% in The Netherlands and 28% in Canada.37,38 / indicates data not available. ...
Introduction:
High cesarean section (CS) rates are observed in patients with inflammatory bowel disease (IBD), but limited data are available to support this decision. We conducted a comprehensive review to evaluate the most appropriate mode of delivery in women with IBD according to disease phenotype and activity, as well as surgical history.
Materials and methods:
We searched MEDLINE (source PubMed) and international conference abstracts, and included all studies that evaluated digestive outcome after delivery in patients with IBD.
Results:
A total of 41 articles or abstracts were screened, and 18 studies were considered in this review, with sample sizes ranging from 4 to 229 patients and follow-up ranging from 2 months to 7.7 years. Pooled CS rates in patients without Perianal Crohn's disease (PCD), healed PCD or active PCD, were 27%, 43%, and 46%, respectively. Regarding the median rate of new PCD (3.0% [IQR, 1.5-11.5] versus 6.5% [0-19.7]) or PCD recurrence (13.5% [3.2-32.7] versus 45% [0-58]), no increase was observed in patients with vaginal delivery compared to CS, but for patients with an active disease, worsening of symptoms was noted in two-thirds of cases. Episiotomy, perianal tears, and instrumental delivery did not influence the incidence of PCD. In patients with ileal pouch anal anastomosis, uncomplicated vaginal delivery seemed to moderately influence pouch function, with no significant difference in terms of overall continence, daytime, or night-time stool frequency, or incontinence. However, these parameters seemed negatively impacted by a complicated vaginal delivery.
Conclusions:
New long-term data from well-designed studies are needed, but our review suggests that systematic CS in patients suffering from IBD should probably be limited to women at risk of perineal tears and obstetric injuries, with an active PCD, or with ileal pouch anal anastomosis.
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.
Episiotomy is a surgically planned incision of the perineum and the posterior vaginal wall in the second stage of labour. It is one of the most commonly performed surgical procedures in the world. In episiotomy, the vaginal orifice is made larger to facilitate the birth of a baby. The postnatal period is very crucial in every mother's life, especially those who had a vaginal delivery and underwent episiotomy. Maternal benefits of episiotomy include reduced risk of perineal trauma, subsequent pelvic floor dysfunction and prolapse, urinary incontinence, faecal incontinence, and sexual dysfunction. Potential benefits for the foetus are thought to include a shortened second stage of labour. However, an episiotomy can also lead to potential adverse consequences, including the extension to a third- or fourth-degree tear, anal sphincter dysfunction, and dyspareunia. Different approaches can be adopted to reduce these complications in the postpartum period, including cleanliness, cold packs, sitz baths, kegel exercises, perineal care, and topical application of dry heat-infrared lamp therapy. Of all these approaches, infrared lamp therapy and sitz baths are the two most effective and commonly used for episiotomy pain relief and wound healing. In infrared lamp therapy, radiant heat or infrared rays are used to produce heat that is then applied to the episiotomy wound to facilitate pain relief and wound healing, while a sitz bath is a moist heat application process that is also effective for episiotomy pain relief and wound healing. This review aims to offer the most thorough understanding of episiotomy, its current concept, and episiotomy pain relief, with a particular focus on infrared lamp therapy and sitz baths.
Background: Findings from research and recommendations from the World Health Organization favors restrictive use of episiotomy, but whether this guidance is being followed in India and factors associated with its use are not known.
Methods: We conducted a secondary analysis of data collected by the Maternal Newborn Health Registry, a prospective population-based pregnancy registry established in Central India (Nagpur, Eastern Maharashtra). We examined mode of delivery and use of episiotomy in vaginal deliveries from 2014 to 2018, as well as maternal and birth characteristics, health systems factors, and concurrent obstetric interventions associations with its use with multivariable Poisson regression models.
Results: During the five-year interval, the rate of episiotomy in vaginal birth rose from 13% to 31% despite a decline in assisted vaginal delivery. In the adjusted analysis prior birth, multiple gestations, seven or more years of maternal education, higher gestational age, higher birthweight, delivery by an obstetrician (as compared to midwife or general physician), and birth in hospital (as compared to clinic or health center) were associated with episiotomy. After adjusting for these factors, year over year rise in episiotomy was significant with an adjusted incidence rate ratio (AIRR) of 1.10 [95% confidence interval (CI) 1.08-1.13; p=0.018]. We found an association between episiotomy and several other obstetrics interventions, with the strongest relationship for maternal treatment with antibiotics (AIRR 4.31, 95% CI 3.17 – 5.87; p=0.003).
Conclusions: Episiotomy in this population-based sample from central India steadily rose from 2014 to 2018. This increase over time was observed even after adjusting for patient characteristics, obstetric risk factors, and health system features, such as specialty of the delivery provider. Our findings have important implications for maternal-child health and respectful maternity care given that most women prefer to avoid episiotomy; they also highlight a potential target for antibiotic stewardship as part of global efforts to combat antimicrobial resistance.
Trial Registration: The trial was registered at ClinicalTrials.gov under reference number NCT01073475.
Introducción: Episiotomía se define como una incisión quirúrgica que se realiza en el periné, región entre la vagina y el ano, para incrementar el diámetro vaginal en el momento del parto. Existen complicaciones derivadas de este procedimiento tales como edema, hematomas, dolor perineal y dehiscencia de episiorrafias. Las dehiscencias se consideran una complicación obstétrica poco común y, a pesar de que las estadísticas al respecto son limitadas, se han reportado tasas de 0.1 a 5.5% de dehiscencia. Objetivo: El objetivo del presente estudio fue evaluar la incidencia de dehiscencia en el puerperio mediato de las episiorrafias realizadas en Centro de Salud Bárbara, San Juan Sacatepéquez (CSB) en el período del 2014-2015 ya que, actualmente se carece de estadísticas al respecto y, aunque es una complicación poco común derivada de este procedimiento, puede tener secuelas importantes en las pacientes obstétricas. Metodología: Se realizó un estudio descriptivo de incidencia acumulada en el cual se utilizaron los expedientes de partos del CSB de los años 2014-2015. Se revisaron las notas de parto de cada una de las pacientes, posteriormente se seleccionaron las papeletas de las pacientes a quienes se les realizó episiotomía y re consultaron en la cita de control de puerperio mediato. Se revisó la nota de evolución en donde se pudo evidenciar la presencia o ausencia de una dehiscencia de episiorrafia. Resultados: Se revisaron 503 records correspondientes al total de partos en 2014 y 2015. Se realizó episiotomía a 171 pacientes (34%). Del total de pacientes a quienes se les realizó episiotomía únicamente 90 re consultaron durante el puerperio mediato, dando una tasa de re consulta de 53%. De las 90 pacientes que re consultaron, se documentó que 6 de ellas presentaban una dehiscencia de episiorrafia, dando una de 7.14 %. Conclusiones: Se concluyó que existe una incidencia de dehiscencia del 7 % durante ese período
Background
Episiotomy in Mexico is highly prevalent and often routine - performed in up to 95% of births to primiparous women. The WHO suggests that episiotomy be used in selective cases, with an expected prevalence of 15%. Training programs to date have been unsuccessful in changing this practice. This research aims to understand how health personal, at four community hospitals in Mexico, perceive episiotomy, both before and after training in respectful maternity care, obstetric and neonatal emergencies.
Methods
This is a descriptive and interpretative qualitative study. We conducted Fifty-three pre and post-intervention (PRONTO© Program) semi-structured interviews with generalists, specialists and nurses (N = 32, 56% women). Thematic analysis was carried out using Atlas-ti© software to iteratively organize codes. Through interpretive triangulation, the team found theoretical saturation and explanatory depth on key analytical categories.
Results
Themes fell into six major themes surrounding their perceptions of episiotomy: as a predictable practice, as a prophylactic intervention, as a procedure that resolves problems in the moment, as a practice that gives the clinician control, as a risky practice, and the role of social norms in practicing it. Results show contradictory discourses among professionals. Despite the growing support for the selective use of episiotomy, it remains positively perceived as an effective prophylaxis for the complications of childbirth while maintaining control in the hands of medical personnel.
Conclusions
Perceptions of episiotomy shed light on how and why routine episiotomy persists, and provides insight into the multi-faceted approaches that will be required to affect this and other harmful obstetrical practices.
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.
Existence and representation of women in media is a popular subject of social sciences, that has been studied from different aspects for many years. The identity and place of women in society are redefined and spread to the public via the ideological apparatuses every day. In the literature of social sciences; a lot of studies revealed that women are represented within the traditional and patriarchal patterns and due to the media contents; unfavorable, wrong and poor portrayals of women in people’s minds are strengthened. Specific to the printed media; the situation stays same for women. They are often subjected to either violent or judicial cases and featured in either magazine or sexually explicit news.
In this study; it will be investigated whether women are still subjects of third news pages and whether the traditional, patriarchal and masculine news presentation continues. In this direction; women-themed news published in national Turkish newspapers BirGün, Sözcü, Yeni Akit and Yeniçağ will be examined between 1-10 February 2019 by means of content analysis method.
Kadının medyadaki varlığı ve temsili; sosyal bilimlerin çeşitli alanlarında uzun yıllardır çalışılan ve farklı açılardan ele alınan bir konudur. Kadının kimliği ve toplumdaki yeri; ideolojik aygıtlar vasıtasıyla her gün yeniden tanımlanmakta ve topluma yayılmaktadır. Literatürde kadının temsilinin ataerkil ve geleneksel kalıplar dâhilinde yapıldığı ve medyanın sunumları vasıtasıyla insanların zihnindeki olumsuz, yanlış ve/ya eksik tasvirlerin günden güne sağlamlaştırıldığı pek çok kez çeşitli araştırmalar aracılığıyla ortaya konmuştur. Yazılı basın özelinde de durum değişmemekte, kadın çoğunlukla şiddet içerikli haberlerin ya da adli vakaların öznesi ya da magazin figürü veya cinsel bir nesne olarak gazetelerde kendine yer bulmaktadır.
Bu çalışmada; günümüzde kadının gazetelerde hala üçüncü sayfa haberlerine sıkışıp sıkışmadığı, ataerkil haber sunumunun, geleneksel kavramların ve eril dilin kullanımının devam edip etmediği gibi sorulara 1 – 10 Şubat 2019 tarihleri arasında yayımlanan ve ulusal yaygın gazeteler olan BirGün, Sözcü, Yeni Akit ve Yeniçağ’da basılan kadın temalı haberler açısından içerik analizi yöntemi kullanılarak incelenecek ve yanıt aranacaktır.
Objective
To determine whether women treated by older physicians are more likely to undergo episiotomy.
Data Sources/Study Setting
Hospital discharge data from Pennsylvania for the period 1994 to 2010.
Study design
We examined the impact of the year in which physicians started delivering babies (a proxy for age) in Pennsylvania on episiotomy rates using a linear probability model with hospital fixed effects.
Data Collection/Extraction Methods
Using diagnosis and procedure codes, we identified women delivering vaginally (N = 1 658 327) and determined the proportion who had an episiotomy.
Principal Findings
The average physician‐level episiotomy rate declined from 54 percent in 1994 to 13 percent in 2010. Rates declined among older and younger physicians, but, at any point in time, women treated by older physicians were more likely to have an episiotomy. A 10‐year difference in physician age is associated with a 6 percentage point increase in episiotomy rates.
Conclusions
Results indicate that older physicians, who entered practice when episiotomy was common, were slow to adjust their practices in response to evidence showing that routine episiotomy is unnecessary.
Introduction: Wound Dehiscence (WD) following Vaginal Delivery (VD) or Cesarean Delivery (CD) causes considerable discomfort to the woman, leading to significant physical, emotional and financial burden. The rate of Perineal Wound Dehiscence (PWD) is relatively low and more common with instrumental delivery. However, there is minimal information on the incidence and risk factors causing WD, especially for PWD. Aim: To assess the incidence and risk factors of peripartum wound dehiscence. Materials and Methods: This retrospective study was conducted in a large tertiary care centre where there were 14759 deliveries. 4671 women had caesarean deliveries and 10,088 women had the vaginal delivery. There were 86 cases (0.8%) of WD in the VD group and 95 (2%) in the CD group. These cases were compared with twice as many controls. Results: Induction of Labour (IOL) and BMI >30 kg/m² were more common in cases compared to controls in the CD group. However, on multivariate analysis, this association was not seen. IOL, meconium stained liquor (MSAF), instrumental delivery and use of episiotomy was more common among cases than controls in the VD group. IOL did not show up as an independent risk factor on multivariate analysis. Conclusion: An association between IOL, primigravidae, instrumental delivery and MSAF was seen with peripartum WD. © 2018, Journal of Clinical and Diagnostic Research. All rights reserved.
Introduction: routine use of episiotomy began to be called into question in the United States in the mid-20th century, but the recommendation for a restrictive use was not generally adopted until the beginning of the 21st century, with all professional societies and agencies making unanimous recommendations on it. Since then, such a recommendation has been included in normal birth care. Purpose: to asses whether or not a reduction in episiotomy rate has occurred at University Hospital of La Ribera resulting from the application of present recommendations on restrictive use. Moreover, the time course of non-damaged perineum rates and perineal tear rates in normal births not using epi-siotomy was evaluated. Methods: a descriptive, cross-sectional, retrospective study was performed. Data from all pregnant women having normal births at University Hospital of La Ribera from 2011 to 2015 were collected. Results: episiotomy rate fell from 33% in 2011 to 17% in 2015. At the same time, the number of non-damaged perinea increased from 33% to 44% and a decreased rate of grade III-IV perineal tears was observed (from 0.68% at the beginning of study period to 0.30% at present). Discussion: selective use of episiotomy at La Ribera, based on a midwives consensus, has resulted in a reduction of episiotomy rate to below the rate recommended by World Health Organization. This is due to a number of factors, including women demands, change of normal birth care, and midwives interest in providing the highest quality in childbirth care and satisfaction for both midwives and women. Conclusions: certainly, a reduction has occurred in episiotomy use rate in normal births at University Hospital of La Ribera since the paradigm change was introduced. A high rate of non-damaged perinea has been achieved in normal births without episiotomy, with a very low rate of grade III-IV perineal tears.
Background:
Eastern African immigrants from countries affected by female genital mutilation have resettled in many developed countries, including Australia. Although possibly at risk of perineal trauma and episiotomy, research investigating their perineal status post-migration is sparse.
Aim:
To investigate variations in episiotomy use and incidence of severe perineal tear for women born in Eritrea, Ethiopia, Somalia and Sudan compared with Australian-born women.
Methods:
A population-based study of 203,206 Australian-born and 3502 Eastern African immigrant women admitted as public patients, with singleton vaginal births between 1999 and 2007, was conducted using the Victorian Perinatal Data Collection. Descriptive and multivariable logistic regression analysis adjusting for confounders selected a priori, were performed to compute incidence and adjusted odds ratios.
Findings:
Overall, 30.5% Eastern African immigrants had episiotomy compared to 17.2% Australian-born women. Severe perineal trauma occurred in 2.1% of Eastern African immigrants and 1.6% of Australian-born women. While the odds of severe perineal trauma was significantly elevated only during non-instrumental vaginal births for Eastern African immigrants {ORadj1.56 95%CI(1.17, 2.12)}; that of episiotomy was increased during both non-instrumental {ORadj4.47 95%CI(4.10, 4.88)} and instrumental {ORadj2.51 95%CI(1.91, 3.29)} vaginal births.
Conclusions:
Overall, Eastern African immigrant women experienced elevated odds of episiotomy and severe perineal tear. Health care providers need to be mindful of the increased risk of severe perineal tear in these women and enhance efforts in identification and treatment of severe perineal trauma to minimise associated short and long term morbidity. Strategies to reduce unneeded episiotomy and ways of enhancing perineal safety are also needed.
This is Part 2 of 5 in the series of evidence statements from the IOC expert committee on exercise and pregnancy in recreational and elite athletes. Part 1 focused on the effects of training during pregnancy and on the management of common pregnancy-related symptoms experienced by athletes. In Part 2, we focus on maternal and fetal perinatal outcomes.
ResearchGate has not been able to resolve any references for this publication.