Mengqin Zhang1,2, Min Wang1,2, Xiufang Zhao1,2, Jianhua Ren1,2, Jie Xiang1,2, Biru Luo1,2, Jianrong Yao1,2. 1. Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, P. R. China. 2. Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, P. R. China.
Abstract
OBJECTIVE: To assess the incidence rates and risk factors for episiotomy during vaginal childbirth in a Western China context. METHODS: A retrospective hospital-based cohort study was conducted using computerized data of 3721 singleton vaginal deliveries after 28 weeks of gestation. Women who underwent episiotomy were compared with those who did not. RESULTS: The overall prevalence of episiotomy was 44.0% (1636/3721); 52.9% (1458/2756) among primiparas and 18.4% (178/965) among multiparas (P < 0.001). Adjusted risk factors significantly associated with episiotomy included primiparity, prolonged second stage of labor, and labor-management personnel. Risk factors specific to primiparas were increasing maternal age (per year) (OR = 1.04, 95% CI 1.01 to 1.07, P = 0.035), increasing biparietal diameter (per centimeter) (OR = 1.40, 95% CI 1.06 to 1.84, P = 0.017), first stage of labor beyond 10-hour (OR = 1.36, 95% CI 1.10 to 1.68, P = 0.005), and birth weight (per 100 g) (OR = 1.06, 95% CI 1.03 to 1.09, P < 0.001). Birth weight resulted in an adjusted risk increase of 6.1% among primiparas for every 100 additional grams of birth weight. For the analysis stratified by labor-management personnel, moderately experienced midwifery was a risk factor of episiotomy (OR = 1.76, 95% CI 1.21 to 2.56, P = 0.003); midwives with bachelor's degree (OR = 1.47, 95% CI 1.15 to 1.88, P = 0.002), and obstetricians with doctor's degree (OR = 2.00, 95% CI 1.18 to 3.39, P = 0.010) were most likely to perform episiotomy. CONCLUSION: Episiotomy is still commonly performed in Western China. A survey of maternity care professionals' knowledge of and attitudes towards episiotomy is urgently required to explore the complex reasons for conducting episiotomy.
OBJECTIVE: To assess the incidence rates and risk factors for episiotomy during vaginal childbirth in a Western China context. METHODS: A retrospective hospital-based cohort study was conducted using computerized data of 3721 singleton vaginal deliveries after 28 weeks of gestation. Women who underwent episiotomy were compared with those who did not. RESULTS: The overall prevalence of episiotomy was 44.0% (1636/3721); 52.9% (1458/2756) among primiparas and 18.4% (178/965) among multiparas (P < 0.001). Adjusted risk factors significantly associated with episiotomy included primiparity, prolonged second stage of labor, and labor-management personnel. Risk factors specific to primiparas were increasing maternal age (per year) (OR = 1.04, 95% CI 1.01 to 1.07, P = 0.035), increasing biparietal diameter (per centimeter) (OR = 1.40, 95% CI 1.06 to 1.84, P = 0.017), first stage of labor beyond 10-hour (OR = 1.36, 95% CI 1.10 to 1.68, P = 0.005), and birth weight (per 100 g) (OR = 1.06, 95% CI 1.03 to 1.09, P < 0.001). Birth weight resulted in an adjusted risk increase of 6.1% among primiparas for every 100 additional grams of birth weight. For the analysis stratified by labor-management personnel, moderately experienced midwifery was a risk factor of episiotomy (OR = 1.76, 95% CI 1.21 to 2.56, P = 0.003); midwives with bachelor's degree (OR = 1.47, 95% CI 1.15 to 1.88, P = 0.002), and obstetricians with doctor's degree (OR = 2.00, 95% CI 1.18 to 3.39, P = 0.010) were most likely to perform episiotomy. CONCLUSION: Episiotomy is still commonly performed in Western China. A survey of maternity care professionals' knowledge of and attitudes towards episiotomy is urgently required to explore the complex reasons for conducting episiotomy.