Risk factors for episiotomy: a case-control study
Open Access
- 1 October 2014
- journal article
- research article
- Published by FapUNIFESP (SciELO) in Revista da Associação Médica Brasileira
- Vol. 60 (5), 465-472
- https://doi.org/10.1590/1806-9282.60.05.015
Abstract
Objective: obtaining information on the factors associated with episiotomy will be useful in sensitizing professionals to the need to minimize its incidence. Therefore, the objective of this study was to evaluate risk factors for episiotomy in pregnant women who had undergone vaginal delivery at a university maternity hospital in northeastern Brazil. Methods: a case-control study was conducted with pregnant women submitted to episiotomy (cases) and pregnant women not submitted to episiotomy (controls) between March 2009 and July 2010 at the Professor Fernando Figueira Integral Medicine Institute (IMIP) in Recife, Brazil, in a ratio of 1 case to 2 controls. The study variables consisted of: whether episiotomy was performed, demographic, obstetric and fetal characteristics (primiparity, analgesia, instrumental delivery, fetal distress, etc.), external factors (day and time of delivery, professional attending delivery) and factors directly related to delivery. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated. Multivariate analysis was performed to determine the adjusted risk of episiotomy. Results: a total of 522 women (173 cases and 349 controls) were included. It was found that deliveries with episiotomy were more likely to have been attended by staff physicians (OR = 1.88; 95%CI: 1.01 - 3.48), to have required forceps (OR = 12.31; 95%CI: 4.9 - 30.1) and to have occurred in primiparas (OR = 4.24; 95%CI: 2.61 - 6.89). The likelihood of a nurse having attended the delivery with episiotomy was significantly lower (OR = 0.29; 95%CI: 0.16 - 0.55). Conclusion: episiotomy was found to be strongly associated with deliveries attended by staff physicians, with primiparity, and with instrumental delivery, and was less common in deliveries attended by nurses.Keywords
This publication has 13 references indexed in Scilit:
- Use of Routine Interventions in Labour and Birth in Canadian Hospitals: Comparing Results of the 1993 and 2007 Canadian Hospital Maternity Policies and Practices SurveysJournal of Obstetrics and Gynaecology Canada, 2011
- Operative Vaginal DeliveryObstetrics & Gynecology, 2010
- Lateral episiotomy protects primiparous but not multiparous women from obstetric anal sphincter ruptureActa Obstetricia et Gynecologica Scandinavica, 2009
- A prospective cohort study of maternal and neonatal morbidity in relation to use of episiotomy at operative vaginal deliveryBJOG: An International Journal of Obstetrics and Gynaecology, 2008
- Selective vs routine midline episiotomy for the prevention of third- or fourth-degree lacerations in nulliparous womenAmerican Journal of Obstetrics and Gynecology, 2008
- Accuracy of ultrasound biometry in the prediction of macrosomia: a systematic quantitative reviewBJOG: An International Journal of Obstetrics and Gynaecology, 2005
- Episiotomy in Low-Risk Vaginal DeliveriesThe Journal of the American Board of Family Medicine, 2005
- ROUTINE USE OF EPISIOTOMY IN MODERN OBSTETRICSObstetrics and Gynecology Clinics of North America, 1999
- The role of conceptual frameworks in epidemiological analysis: a hierarchical approach.International Journal of Epidemiology, 1997
- Factors associated with the use of episiotomy during vaginal deliveryObstetrics & Gynecology, 1996