Rates and Predictors of Episiotomy in Nigerian Women

Abstract

Background: Despite many years of it being practised, episiotomy has remained controversial operation.

Objectives: To determine (1) the rates of episiotomies in two tertiary care Nigerian obstetric populations; (2) the predictors of a parturient receiving an episiotomy and (3) the frequency, and type, of perineal injuries when an episiotomy is avoided in a given parturient and (4) whether parturients in the centres were taught the technique of antenatal perineal massage.

Methods: A retrospective analysis of consecutive vaginal deliveries by women at two Nigerian tertiary hospitals from 1st May to 30th June 2002.

Results: Out of the 433 vaginal deliveries with complete data, 175 women (40.4%) had an episiotomy performed during delivery while the remaining 258 (59.6%) did not. Of these 258 women who did not have an episiotomy, 77 (29.8%) sustained a first-degree perineal tear, 2 (0.8%) a second-degree perineal tear, 0(0.0%) a third-degree perineal tear while in 179 (69.4%), the perineum remained intact. The women who had an episiotomy had greater postpartum blood loss than those who did not have an episiotomy (mean recorded blood loss: 328 ± 345 versus 235 ± 337 mls, p = 0.04). The significant predictors of a parturient having an episiotomy were: maternal age less than 30 years compared to those 30 years and older (OR = 1.6, 95% CI = 1.3 to 2.0, p = 0.000) and primigravidity compared to other gravidas (OR = 3.1, 95% CI = 2.4 to 3.9, p = 0.000).

Conclusions: The episiotomy rate among Nigerian parturients is 40%. Maternal age less than 30 years and primigravidity are significant predictors of episiotomy. Perineal lacerations are associated with less blood loss than episiotomies. Finally, Nigerian parturients should be taught the technique of antenatal perineal massage since this prevents both episiotomies and perineal lacerations.
Key Words: Episiotomy, rate, predictors, Nigeria.

[ Trop J Obstet Gynaecol, 2004;21:44-45]