Episiotomy in Southern Brazil: prevalence, trend, and associated factors

Juraci A.  Cesar; Luana P. Marmitt; Raúl A.  Mendoza-Sassi

doi:10.11606/s1518-8787.2022056003908

Authors

Juraci A. Cesar Universidade Federal do Rio Grande. Faculdade de Medicina. Programa de Pós-graduação em Saúde Pública. Rio Grande, RS, Brasil http://orcid.org/0000-0003-0864-0486
Luana P. Marmitt Universidade do Oeste de Santa Catarina. Programa de Pós-Graduação em Biociências e Saúde. Flor da Serra, SC, Brasil https://orcid.org/0000-0003-0526-7954
Raúl A. Mendoza-Sassi Universidade Federal do Rio Grande. Faculdade de Medicina. Programa de Pós-graduação em Saúde Pública. Rio Grande, RS, Brasil https://orcid.org/0000-0002-4641-9056

DOI:

https://doi.org/10.11606/s1518-8787.2022056003908

Keywords:

Episiotomy, trends, Prevalence, Risk Factors, Socioeconomic Factors

Abstract

OBJECTIVE To identify and analyze the prevalence, trend, and factors associated with episiotomy in Rio Grande, in the state of Rio Grande do Sul, Southern Brazil. METHODS A single, standardized questionnaire was applied to all pregnant women, residents in the municipality of Rio Grande, who had children in local hospitals between January 1 and December 12 of the years 2007, 2010, 2013, 2016 e 2019. Demographic and socioeconomic characteristics were investigated, as well as the assistance received during pregnancy and delivery. Chi-square test was used to compare proportions and Poisson regression with robust variance adjustment was used for multivariable analysis. Prevalence ratio (PR) was used as effect measure. RESULTS Among the 12,645 births that occurred in the five years, 5,714 (45.2%) were vaginal delivery. Of these mothers, 2,930 (51.3%; 95%CI: 50.0%–52.6%) underwent episiotomy. Over this period, the episiotomy rate decreased from 70.9% (68.4–73.5) in 2007 to 19.4% (17.1–21.7) in 2019. Adjusted analysis showed a high PR of episiotomy occurrence among women who were young (PR = 2.23; 95%CI: 1.89–2.63), had higher education (PR = 1.21; 95%Cl: 1.03–1.42), had a higher family income (PR = 1.25; 95%CI: 1.10–1.41), were primiparous (PR = 3.41; 95%CI: 2.95–3.95), had prenatal care in the private sector (PR = 1.25; 95%CI: 1.07–1.46), had oxytocin-induced labor (PR = 1.18; 95%CI:1.09–1.27), underwent forceps (PR = 1.32; 95%CI: 1.16–1.50), and whose newborn weighed 4,000 g or more (PR = 1.43; 95%CI: 1.14–1.80). CONCLUSION Although the prevalence of episiotomy fell sharply within the studied period, its occurrence is more likely among women at lower risk of birth complications.

References

Barjon K, Mahdy. Episiotomy: continuing education activity. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2021. [cited 2021 Aug 21]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546675/

Ghulmiyyah L, Sinno S, Mirza F, Finianos E, Nassar AH. Episiotomy: history, present and future – a review. J Matern Fetal Neonatal Med. 2020 Apr 26:1-6. https://doi.org/10.1080/14767058.2020.1755647. Epub ahead of print.

Shmueli A, Benziv RG, Hiersch L, Ashwal E, Aviram R, Yogev Y, et al. Episiotomy: risk factors and outcomes. J Matern Fetal Neonatal Med. 2017;30(3):251-6. https://doi.org/10.3109/14767058.2016.1169527

Jiang H, Qian X, Carroli G, Garner P. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev. 2017;(2):CD000081. https://doi.org/10.1002/14651858.CD000081.pub3

Schantz C, Sim KL, Ly EM, Barennes H, Sudaroth S, Goyet S. Reasons for routine episiotomy: a mixed-methods study in a large maternity hospital in Phnom Penh, Cambodia. Reprod Health Matters. 2015;23(45):68-77. https://doi.org/10.1016/j.rhm.2015.06.012

Seijmonsbergen-Schermers AE, Geerts CC, Prins M, Diem MT, Klomp T, Lagro-Janssen ALM, et al. The use of episiotomy in a low-risk population in the Netherlands: a secondary analysis. Birth. 2013;40(4):247-55. https://doi.org/10.1111/birt.12060

Coulm B, Le Ray C, Lelong N, Drewniak N, Zeitlin J, Blondel B. Obstetric interventions for low-risk pregnant women in France: do maternity unit characteristics make a difference? Birth. 2012;39(3):183-91. https://doi.org/10.1111/j.1523-536X.2012.00547

Levitt C, Hanvey L, Bartholomew S, Kaczorowski J, Chalmers B, Heaman M, et al. Use of routine interventions in labour and birth in Canadian hospitals: comparing results of the 1993 and 2007 Canadian hospital maternity policies and practices surveys. J Obstet Gynaecol Can. 2011;33(12):1208-17. https://doi.org/10.1016/S1701-2163(16)35104-0

Leal MC, Bittencourt SA, Esteves-Pereira AP, Ayres BVS, Silva LBRAA, Thomaz EBAF, et al. Progress in childbirth care in Brazil: preliminary results of two evaluation studies. Cad Saude Publica. 2019;22;35(7):e00223018. https://doi.org/10.1590/0102-311X00223018

Kettle C, Tohill S. Perineal care. BMJ Clin Evid. 2011;4:1401.

Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap): a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-81. https://doi.org/10.1016/j.jbi.2008.08.010

Lauritsen JM, editor. EpiData data entry, data management and basic statistical analysis system. Odense (DK): EpiData Association; 2000-2008.13. Dean A, Arner T, Sunki G, Friedman R, Lantinga M, Sangam S, et al. Epi InfoTM, a database and statistics program for public health professionals. Atlanta, GA: CDC; 2011.

Cesar JA, Mendoza-Sassi RA, Marmitt LP. Evolution of care during pregnancy and childbirth in the extreme south of Brazil. Rev Saude Publica. 2021;55:50. https://doi.org/10.11606/s1518-8787.2021055003128

Clesse C, Lighezzolo-Alnot J, De Lavergne S, Hamlin S, Scheffler M. Statistical trends of episiotomy around the world: comparative systematic review of changing practices. Health Care Women Int. 2018;39(6):644-62. https://doi.org/10.1080/07399332.2018.1445253

World Health Organization, Maternal Health and Safe Motherhood Programme. Care in normal birth: a practical guide: report of a technical working group. Geneva (CH): WHO Maternal and Newborn Health/Safe Motherhood Unit, Family and Reproductive Health; 1996.

Friedman AM, Ananth CV, Prendergast E, D’Alton ME, Wright JD. Variation in and factors associated with use of episiotomy. JAMA. 2015;313(2):197-9. https://doi.org/10.1001/jama.2014.14774

Clesse C, Cottenet J, Lighezzolo-Alnot J, Goueslard K, Scheffer M, Sagot P, et al. Author Correction: Episiotomy practices in France: epidemiology and risk factors in non-operative vaginal deliveries. Sci Rep. 2021;11:6839 (2021). https://doi.org/10.1038/s41598-021-85717-1

Räisänen S, Vehviläinen-Julkunen K, Gisler M, Heinonen S. A population-based register study to determine indications for episiotomy in Finland. Int J Gynecol Obstet. 2011;115:26-30. https://doi.org/10.1016/j.ijgo.2011.05.008

Goueslard K, Cottenet J, Roussot A, Clesse C, Sagot P, Quantin C. How did episiotomy rates change from 2007 to 2014? Population-based study in France. BMC Pregnancy Childbirth. 2018;18:208. https://doi.org/10.1186/s12884-018-1747-8

Carmo Leal M, Pereira APE, Domingues RMSM, Theme Filha MM, Dias MAB, Nakamura-Pereira M, et al. Obstetric interventions during labor and childbirth in Brazilian low-risk women. Cad Saude Publica. 2014;30 Suppl 1:S1-16. https://doi.org/10.1590/0102-311X00151513

Cunha CMP, Katz L, Lemos A, Amorim MM. Knowledge, attitude and practice of Brazilian obstetricians regarding episiotomy. Rev Bras Ginecol Obstet. 2019;41(11):636-46. https://doi.org/10.1055/s-0039-3400314

Gama SGN, Viellas EF, Medina ET, Angulo-Tuesta A, Silva CKRT, Silva SD, et al. Delivery care by obstetric nurses in maternity hospitals linked to the Rede Cegonha, Brazil - 2017. Cien Saude Colet. 2021;26(3):919-29. https://doi.org/10.1590/1413-81232021263.2848

Barros AJD, Victora CG, Horta BL, Wehrmeister FC, Bassani DG, Silveira MF, et al. Antenatal care and caesarean sections: trends and inequalities in four population based birth cohorts in Pelotas, Brazil, 1982-2015. Int J Epidemiol. 2019;48 Suppl 1:i37-45. https://doi.org/10.1093/ije/dyy211

Chuilon AL, Le Ray C, Prunet C, Blondel B. [Episiotomy in France in 2010: variations according to obstetrical context and place of birth]. J Gynecol Obstet Biol Reprod (Paris). 2016;45(7):691-700. French. https://doi.org/10.1016/j.jgyn.2015.10.005

Lutomski JE, Murphy M, Devane D, Meaney S, Greene RA. Private health care coverage and increased risk of obstetric intervention. BMC Pregnancy Childbirth. 2014;14:13. https://doi.org/10.1186/1471-2393-14-13

Escuriet R, Pueyo MJ, Perez-Botella M, Espada X, Salgado I, Gómez A, et al. Cross-sectional study comparing public and private hospitals in Catalonia: is the practice of routine episiotomy changing? BMC Health Serv Res. 2015;15:95. https://doi.org/10.1186/s12913-015-0753-z

Prado DS, Mendes RB, Gurgel RQ, Barreto IDC, Bezerra FD, Cipolotti R, et al. Practices and obstetric interventions in women from a state in the Northeast of Brazil. Rev Assoc Med Bras. 2017;63(12):1039-48. https://doi.org/10.1590/1806-9282.63.12.1039

Hernández-Martínez A, Martínez-Galiano JM, Rodríguez-Almagro J, Delgado-Rodríguez M, Gómez-Salgado J. Evidence-based birth attendance in Spain: private versus public centers. Int J Environ Res Public Health. 2019;16(5):894. https://doi.org/10.3390/ijerph16050894

Ismail KMK, editor. Perineal trauma at childbirth. Cham (CH): Springer International Publishing; 2016 [cited 2022 Feb 02]. Available from: http://link.springer.com/10.1007/978-3-319-14860-1

Episiotomy in Southern Brazil: prevalence, trend, and associated factors

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