A-L Chuilon1, C Le Ray2, C Prunet3, B Blondel3. 1. Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, université Paris Descartes, DHU risques et grossesse, 75014 Paris, France; École de sages-femmes Baudelocque, université Paris Descartes, AP-HP, 75014 Paris, France. Electronic address: anne-lise.chuilon@laposte.net. 2. Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, université Paris Descartes, DHU risques et grossesse, 75014 Paris, France; Maternité Port-Royal, université Paris Descartes, groupe hospitalier Cochin, Broca Hôtel-Dieu, DHU risques et grossesse, AP-HP, 75014 Paris, France. 3. Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, université Paris Descartes, DHU risques et grossesse, 75014 Paris, France.
Abstract
OBJECTIVES: To analyze episiotomy rates according to the characteristics of women and maternity units and to study the variability of rates between units and regions. MATERIALS AND METHODS: Our study included all vaginal deliveries in the National Perinatal Survey 2010 (n=11,322). We estimated the adjusted relative risk of episiotomy (aRR) according to women and maternity units characteristics, and we studied the variance between regions and hospitals using multilevel Poisson regressions, stratified on parity. RESULTS: In 2010, 44.7% of primiparous; 14.2% in multiparous had an episiotomy. The main associated factors were Asian origin (primiparae: aRR=1.32 [1.16-1.51]; multiparae: aRR=2.30 [1.67-3.16]), breech presentation (primiparae: aRR=2.14 [1.87-2.21]; multiparae: aRR=3.32 [2.52-4.38]) and operative vaginal delivery (primiparae: aRR=2.04 [1.89-2.11]; multiparae: aRR=3.19 [2.74-3.72]). Rates varied dramatically between regions (primiparae: 17 to 64%; multiparae: 3 to 21%). The variance was significant between regions and between maternity units after controlling for women and units characteristics. CONCLUSION: It would be useful to study the attitudes and views of obstetricians and midwives about the protection of the perineum to better understand these differences in practice.
OBJECTIVES: To analyze episiotomy rates according to the characteristics of women and maternity units and to study the variability of rates between units and regions. MATERIALS AND METHODS: Our study included all vaginal deliveries in the National Perinatal Survey 2010 (n=11,322). We estimated the adjusted relative risk of episiotomy (aRR) according to women and maternity units characteristics, and we studied the variance between regions and hospitals using multilevel Poisson regressions, stratified on parity. RESULTS: In 2010, 44.7% of primiparous; 14.2% in multiparous had an episiotomy. The main associated factors were Asian origin (primiparae: aRR=1.32 [1.16-1.51]; multiparae: aRR=2.30 [1.67-3.16]), breech presentation (primiparae: aRR=2.14 [1.87-2.21]; multiparae: aRR=3.32 [2.52-4.38]) and operative vaginal delivery (primiparae: aRR=2.04 [1.89-2.11]; multiparae: aRR=3.19 [2.74-3.72]). Rates varied dramatically between regions (primiparae: 17 to 64%; multiparae: 3 to 21%). The variance was significant between regions and between maternity units after controlling for women and units characteristics. CONCLUSION: It would be useful to study the attitudes and views of obstetricians and midwives about the protection of the perineum to better understand these differences in practice.
Keywords:
Caractéristiques des femmes; Caractéristiques des maternités; Différences régionales; Episiotomy; Maternity unit characteristics; Regional differences; Women characteristics; Épisiotomie
Authors: Teresa Janevic; Natalia N Egorova; Jennifer Zeitlin; Amy Balbierz; Paul L Hebert; Elizabeth A Howell Journal: Med Care Date: 2018-06 Impact factor: 2.983