E Lesieur1, J Blanc2, A Loundou3, M Dubuc4, F Bretelle5. 1. Service de gynécologie obstétrique, maternité, Gynépôle Marseille, hôpital Nord, chemin des Bourrely, 13015 Marseille, France. Electronic address: emmanuelle.lesieur@ap-hm.fr. 2. Service de gynécologie obstétrique, maternité, Gynépôle Marseille, hôpital Nord, chemin des Bourrely, 13015 Marseille, France. 3. Unité d'aide méthodologique, EA 3279 santé publique et maladies chroniques, faculté de médecine de la Timone, Aix-Marseille université, AP-HM, 13005 Marseille, France. 4. Service de santé publique et d'information médicale, hôpital Nord, AP-HM, 13015 Marseille, France. 5. Réseau méditerranée (PACA Corse Monaco), department of gynaecology and obstetrics, Gynépole, hôpital Nord, Aix-Marseille université (AMU), Assistance publique-Hôpitaux de Marseille, 13015 Marseille, France; Unité de recherche sur les maladies infectieuses tropicales et émergentes, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix-Marseille université, 13005 Marseille, France.
Abstract
OBJECTIVE: To evaluate professional practices relative to episiotomies in the Provence Alpes Côte d'Azur (PACA) region by analysing their incidence in maternity hospitals, by type and by sector of activity. Following this, to analyse maternal and obstetric characteristics associated with episiotomies and the occurrence of perineal tears in Marseille's university hospitals (CHU). METHODS: Data were extracted from the database for the period from 1st January 2012 to 31 December 2014. The sample included 41 maternity hospitals: 13 private and 28 public. Twenty of the maternity hospitals were level 1, 15 were level 2, and 2 were level 3 (Nice and AP-HM). RESULTS: In the PACA region, 176,573 patients gave birth by vaginal delivery. The incidence of episiotomy over the 3 years was 21.6% (0.50% - 76.13%) with a statistically significant reduction in the incidence between 2012 and 2014 (P<0.001). There was a significant difference by sector (P<0.001) and level (P<0.001) of maternity hospitals. In the Marseille CHU, 21.6% of women had an episiotomy (66.4% in primiparas - 33.6% in multiparous) and 43% had perineal tears (62.3% in primiparas - 37.7% in multiparous). After multivariate analysis, gender, weight of the newborn, presentation, gestational age, and mode of delivery were shown to be factors significantly associated with occurrence of episiotomy and occurrence of perineal tear (P<0.001). CONCLUSION: A significant decrease in the incidence of episiotomy was observed in the PACA region from 2012 to 2014, associated with a wide variation in rates depending on the maternity hospitals, their types and their sectors.
OBJECTIVE: To evaluate professional practices relative to episiotomies in the Provence Alpes Côte d'Azur (PACA) region by analysing their incidence in maternity hospitals, by type and by sector of activity. Following this, to analyse maternal and obstetric characteristics associated with episiotomies and the occurrence of perineal tears in Marseille's university hospitals (CHU). METHODS: Data were extracted from the database for the period from 1st January 2012 to 31 December 2014. The sample included 41 maternity hospitals: 13 private and 28 public. Twenty of the maternity hospitals were level 1, 15 were level 2, and 2 were level 3 (Nice and AP-HM). RESULTS: In the PACA region, 176,573 patients gave birth by vaginal delivery. The incidence of episiotomy over the 3 years was 21.6% (0.50% - 76.13%) with a statistically significant reduction in the incidence between 2012 and 2014 (P<0.001). There was a significant difference by sector (P<0.001) and level (P<0.001) of maternity hospitals. In the Marseille CHU, 21.6% of women had an episiotomy (66.4% in primiparas - 33.6% in multiparous) and 43% had perineal tears (62.3% in primiparas - 37.7% in multiparous). After multivariate analysis, gender, weight of the newborn, presentation, gestational age, and mode of delivery were shown to be factors significantly associated with occurrence of episiotomy and occurrence of perineal tear (P<0.001). CONCLUSION: A significant decrease in the incidence of episiotomy was observed in the PACA region from 2012 to 2014, associated with a wide variation in rates depending on the maternity hospitals, their types and their sectors.