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Episiotomy revisited: experience from a tertiary health facility


Kehinde Osazee
J Osaikhuwuomwan

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 1st 2011 to December 31st 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

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eISSN: 1117-4153