Episiotomy revisited: experience from a tertiary health facility

Abstract

Episiotomy remains a commonly performed surgical procedure in obstetrics. This study  determined the factors associated with its use and the materno-foetal sequel following the procedure. This was a retrospective case control study of consecutive deliveries in a tertiary hospital. While subjects were parturients who had episiotomy, the controls were those who did not have episiotomy over the same period. Obstetric data accumulated over a period of twelve months (January 1^st 2011 to December 31^st 2011) installed in the Department of Obstetrics and Gynaecology data base for obstetric patients were retrieved for analysis. Overall, the incidence of episiotomy was 39.4%. Primigravid vaginal births were more likely to have an episiotomy 398 (72.6%) of 548 and especially so if they were young i.e. below 20 years. Majority of episiotomies were performed by midwives 552 (89.9%) compared to doctors 62 (10.1%). Another determinant was a prolonged second stage of labour. Mean APGAR scores of neonates delivered with episiotomies was 7.365 + 0.303 was lower than that for controls 7.753 + 0.352, but there was no difference in incidence of asphyxia. The mean estimated blood loss at delivery was significantly higher for subjects 176.06ml + 20.317 compared with 142.66ml + 16.578 for controls. Nevertheless, blood loss for both test and control groups were within normal range. Episiotomy did not significantly increase the length of hospital stay 2.713 days + 0.149 compared with 2.322 days + 0.188 for controls. We conclude that episiotomy still remains a widely practiced obstetric intervention today. The cadre of accoucheur, age/parity of parturient and the duration of the second stage of labour are important obstetric antecedents with no significant difference on materno-foetal outcome.

Keywords: episiotomy, labour, intrapartum care, materno-foetal, obstetric procedures