FACTORS ASSOCIATED WITH THE SELECTIVE PRACTICE OF EPISIOTOMY IN A UNIVERSITY HOSPITAL
Keywords:
episiotomy, parity, pregnancyAbstract
Objective
To evaluate the prevalence of episiotomy at a university hospital when selective episiotomy was implemented as the standard of care as well as the factors associated with this procedure.
Methods
A cross-sectional study was conducted with a sample of 323 women who had live birth through vaginal delivery from )une to August 2000. Maternal variables (age, place of living and parity), newborn variables (birthweight, gestational age and Apgar score) and those related to assistance (professional in charge and time of procedure) were obtained through maternal interview and patient records. The statistical analysis was performed with the distribution of categories of variables between the groups with and without episiotomy and the differences
evaluated by the x2 test. The Prevalence Ratio (PR and 95%CI) was estimated for
each possible associated factor.
Results
The prevalence of episiotomy was 37.8% in the studied sample. A significantly higher proportion of episiotomy was found among adolescents (PR 2.02, 95%CI 1, 16-3.52) and primiparous (PR 3.96 95%CI 1.97-7.95) when compared with women ? 30 years and multiparous, respectively. The proportion of episiotomy made during the day (42.5%) was higher than during the night (31.7%), however this difference was not significant. No significant association was found between episiotomy and variables associated with the newborn and the professional in charge of the delivery.
Conclusion
The prevalence of episiotomy was higher than the international recommendation. Episiotomy was shown to be associated with low maternal age and primiparity.
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References
Cunningham FG, Gant NF, Leveno KJ, et ai. Williams Obstetrics. 21st ed. New York: McGraw-Hill; 2001. p.325-8.
Schoon PG. Episiotomy: yea or nay. Obstet Gynecol Surv. 2001; 56(11):667-9.
Carroli G, Belizan J. Episiotomy for vaginal birth (Cochrane Review). ln: The Cochrane Library; issue 2; 2005. Oxford: Update Software.
Woolley RJ. Benefits and risks of episiotomy: a review of the English-language literature since 1980-part 1. Obstet Gynecol Surv. 1995; 50(11):806-20.
Borges BB, Serrano F, Pereira F. Episiotomia: uso generalizado versus selectivo. Acta Med Port. 2003; 16(6):447-54.
Thacker SB, Banta HD. Benefits and risks of episiotomy: an interpretative review of the english language literature, 1860-1980. Obstet Gynecol Surv. 1983; 38(6):322-38.
Argentine Episiotomy Triai Collaborative Group. Routine versus selective episiotomy: a randomised controlled triai. Lancet. 1993; 342(8886): 1517-8.
Riffel MJ. Episiotomia: a dimensão oculta [disser tação]. Florianópolis: Universidade Federal de Santa Catarina; 1997.
Rezende, J. Obstetrícia. 9a. ed. Rio de Janeiro: Guanabara-Koogan; 2001. p.336-9.
Neme, B. Obstetrícia básica. 2a. ed., São Paulo: Sarvier; 2000. p.203-5.
Febrasgo. Manual de Assistência ao Parto e Tocurgia. São Paulo; 2002. p.48-9.
Diniz SG, Chacham AS. "The cut above" and "the cut below": the abuse of caesareans and episiotomy in Sao Paulo, Brazil. Reprod Health Matters. 2004; 12(23) 100-10.
Althabe F, Belizán JM, Bergel E. Episiotomy rates in primiparous women in Latin America:hospital based descriptive study. BMJ. 2002; 324(7343):945-6.
Eason E, Labrecque M, Marcoux S, Mondor M. Anal incontinence after childbirth. CMAJ. 2002; 166(3): 326-30
Gregory WT, Nygaard 1. Childbirth and pelvic floor disorders. Clin Obstet Gynecol. 2004; 47(2):394-403.
6. Sartore A, De Seta F, Maso G, Pregazzi R, Grimaldi E, Guaschino S. The effects of mediolateral episiotomy on pelvic floor function after vaginal delivery Obstet Gynecol. 2004; 103(4):669-73
Goer H. Obstetric myths versus research realities. Westport: Bergin & Garvey; 1995. p.275-93.
Dannecker C, Hillemanns P, Strauss A, Hasbargen U, Hepp H, Anthuber C. Episiotomy and perineal tears presumed to be imminent: randomized controlled triai. Acta Obstet Gynecol Scand. 2004; 83(4):364-8
Martins-Costa S, Ramos JGL, Brietzke E, Stuczinski JV, Dias EC. Episiotomia: o que há de verdade neste tradicional procedimento? Femina. 2001; 29(4):201-4.
Janni W, Schiessl B, Peschers U, Huber S, Strobl B, Hantschmann P, et ai. The prognostic impact of a prolonged second stage of labor on maternal and fetal outcome. Acta Obstet Gynecol Scand. 2002; 81(3):214-21.
Webb DA, Culhane J. Time of day variation in rates of obstetric intervention to assist in vaginal delivery. J Epidemio! Community Health. 2002; 56(8):577-8
Buekens P, Belizán JM. lmproving prenatal care in Latin America. [cited 2005 Oct 11]. Available from: http://gn.rti.org/resunits/index.cfm
