Background: Episiotomy is a surgical incision into the perineum and posterior vaginal wall during the second stage of labor to increase the diameter of the soft tissue pelvic outlet to facilitate delivery. Episiotomy rates vary from population to population. Limited information exists related to the practice of episiotomy in Ethiopia.
Objective: To assess the prevalence of episiotomy practice and associated factors at three teaching hospitals (Tikur Anbessa Hospital, Gandhi Memorial Hospital, and Zewditu Memorial Hospital) in Addis Ababa Ethiopia.
Method and Materials: Hospital-based cross-sectional study was conducted from January 2022 to March 2022 on 386 mothers who had a vaginal delivery in the three hospitals. A structured questionnaire was used to collect data. The data was entered, coded, and analyzed using Statistical Package for Social Science (SPSS) version 25. Binary and multivariable logistic regression analyses were performed. P value ≤ 0.05 was used to determine the level of statistically significant variables.
Results: The prevalence of episiotomy was 49%. Age ≤24 years (AOR=0.17, 95%CI=0.055, 0.52), operative vagainal delivery (vacuum AOR=3.1, 95%CI=1.50,18.67 and forceps AOR=3.5, 95%CI=1.87, 11.06), duration of second stage of labor ≥2HR (AOR=3.5, 95%CI=1.87, 11.06), birth weight of newborn ≥4000 grams (AOR=5.3, 95%CI=95%CI, 1.28, 22.02) and FGM (AOR=2.8, 95%CI=1.64, 4.94) were factors significantly associated with episiotomy practice.
Conclusion: The prevalence of episiotomy in this study (49%) is higher than the WHO’s recommendation (10%). Variables that remained associated significantly with episiotomy were maternal age, instrument delivery, duration of the second stage of labor ≥2HR, newborn weighing ≥4000 grams, and FGM. An effort should be made to reduce the prevalence of episiotomy by adhering to the correct indications and preparing periodic on-job training regarding the indication of episiotomy to all obstetric care providers.
Episiotomy, prevalence of episiotomy, factors associated with episiotomy
2. Carvalho C, Souza A, Moraes Filho OB. Prevalence and factors associated with the practice of episiotomy at a maternity school in Recife, Pernambuco, Brazil. Revista da Associacao Medica Brasileira (1992). 2010;56(3):333-9.
3. Fikadu KB, N. Tadesse, B. Mesele, D. Aschenaki, E. Toka, E. Arega, F. Girma, T. Paulos, A. Magnitude of Episiotomy and Associated Factors among Mothers Who Give Birth in Arba Minch General Hospital, Southern Ethiopia: Observation-Based Cross-Sectional Study. J Pregnancy. 2020;2020:8395142.
4. Franchi MP, Francesca Lazzari, Cecilia Garzon, Simone Laganà, Antonio Simone Raffaelli, Ricciarda Cromi, Antonella Ghezzi, Fabio. Selective use of episiotomy: what is the impact on perineal trauma? Results from a retrospective cohort study. Archives of gynecology and obstetrics. 2020;301(2):427-35.
5. Carroli G, & Mignini, L. . Episiotomy for vaginal birth. The Cochrane database of systematic reviews. 2009;(1), CD000081. https://doi.org/10.1002/14651858.CD000081.pub2.
6. Flora MB da Silva SMdO, Debra Bick, Ruth H Osava, Esteban F Tuesta and Maria LG Riesc. Risk factors for birth-related perineal trauma. Journal of Clinical Nursing. 2012(CLINICAL ISSUES):10.
7. Episiotomy Rates Around the World: An Update [Internet]. BIRTH 2005.
8. Variation in and factors associated with the use of episiotomy [Internet]. JAMA. 2015 Jan 13.
9. OT Oladapo ÖT, M Bonet,TA Lawrie,A Portela,S Downe,AM Gülmezoglu. WHO model of intrapartum care for a positive childbirth experience: transforming the care of women and babies for improved health and wellbeing. BJOG An International Journal of obstetrics and gynecologyJuly 2018. p. 8.
10. Worku SA MY, Getahun SA. Episiotomy Practice and its Associated Factor among Women Who Gave Birth at Public Health Institutions of Akaki Kality in Addis Ababa, Ethiopia. Clinics Mother Child Health. 2019;16:318. doi:10.24105/2090-7214.16.318.
11. Agency) CCS. Population Projection of Ethiopia for the Year 2014. Federal Democratic Republic of Ethiopia, Central Statistical Agency, Addis Ababa, . Scientific research. 2013;4-38.
12. Niguse KG, Gebreamlak Gebrehiwot, Haftom Abay, Mebrahtu Getachew, Darie Worku, Temesgen. Episiotomy Practice and its associated factors among mothers who gave birth vaginally at public health institutions of Shire Town, Northern Ethiopia. Infection. 2016;8:9.
13. Pasc A, Navolan D, Puscasiu L, Ionescu CA, Szasz FA, Carabineanu A, et al. A multicenter cross-sectional study of episiotomy practice in Romania. J Eval Clin Pract. 2019;25(2):306-11.
14. Teshome YM, Mengistu Sisay, Tariku Chala, Getahun Mengistu, Amanuael Shewasinad, Sisay Worku, Negese. Prevalence of Episiotomy and Its Associated Factors in University of Gondar Comprehensive Specialized Referral Hospital: A Retrospective Study from Ethiopia. American Journal of Life Sciences. 2020;8(1):9.
15. Tefera TK, Birhanu Mekonen, Tadios. Prevalence of episiotomy and factors associated with Practice of episiotomy at Saint Paul’s Hospital Millennium Medical College: a cross sectional study. Ethiopian Journal of Reproductive Health. 2019;11(3):8.
16. Beyene FN, A. A. Limenih, S. K. Tesfu, A. A. Wudineh, K. G. Factors Associated with Episiotomy Practices in Bahirdar City, Ethiopia: A Cross-Sectional Study. Risk Manag Health Policy. 2020;13:2281-9.
17. Gachon B, Fritel, X., Rivière, O. et al. French guidelines for restrictive episiotomy during instrumental delivery were not followed by an increase in obstetric anal sphincter injury. Sci Rep 2022;12, 6330 . https://doi.org/10.1038/s41598-022-10379-6.