Episiotomy: a medicolegal vicious cycle

Zaami, Simona; Zupi, Errico; Lazzeri, Lucia; Centini, Gabriele; Stark, Michael; Malvasi, Antonio; Signore, Fabrizio; Marinelli, Enrico

doi:10.23736/s0031-0808.20.03946-4

Cited by 6 publications

(3 citation statements)

References 43 publications

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“…Furthermore, water immersion may reduce episiotomy rates ( 15 , 16 ). Nonetheless, a lack of high-quality evidence clouded informed decisions about the advantages and disadvantages of water birth ( 17 ). Therefore, the merit and risks of water birth should be discussed thoroughly with the parturient during the process of informed decision making with mothers interested in this option ( 16 ).…”

Section: Introductionmentioning

confidence: 99%

Episiotomy Practice and Its Associated Factors in Africa: A Systematic Review and Meta-Analysis

et al. 2022

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BackgroundEpisiotomy, a surgical procedure that enlarges the vaginal opening during childbirth, was common practice until the early 2000s. Other sources, including the World Health Organization (WHO), advocate for the selective use of episiotomy. Episiotomy rates, on the other hand, have remained high in developing countries, while declining in developed countries. As a result, the current study sought to determine the overall prevalence of episiotomy in Africa as well as the risk factors associated with its practice.MethodsArticles were searched in international electronic databases. A standardized Microsoft Excel spreadsheet and STATA software version 14 were used for data extraction and analysis, respectively. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was used to write this report. A random-effects meta-analysis model was used to determine the pooled prevalence of episiotomy. A heterogeneity test was conducted using I-Squared (I2) statistics. Egger's test and funnel plots were conducted to detect publication bias. Subgroup analysis was also conducted. Association was expressed through a pooled odds ratio (OR) with a 95% Confidence Interval (CI).ResultA total of 21 studies with 40,831 participants were included in the systematic review and meta-analysis. The pooled prevalence of episiotomy practice was 41.7% [95% CI (36.0–47.4), I2 = 99.3%, P < 0.001). Primiparity [OR: 6.796 (95% CI (4.862–9.498)), P < 0.001, I2: 95.1%], medical doctors- assisted delivery [OR: 3.675 (95% CI (2.034–6.640)), P < 0.001, I2: 72.6%], prolonged second stage of labor [OR: 5.539 (95% CI (4.252–7.199)), P < 0.001, I2: 0.0%], using oxytocin [OR: 4.207 (95% CI (3.100–5.709)), P < 0.001, I2: 0.0%], instrument -assisted vaginal delivery [OR: 5.578 (95% CI (4.285–7.260)), P < 0.001, I2: 65.1%], and macrosomia [OR: 5.32 (95% CI (2.738–10.339)), P < 0.001, I2: 95.1%] were factors associated with episiotomy practice.ConclusionIn this review, the prevalence of episiotomy among African parturients was high. A selective episiotomy practice should be implemented to reduce the high episiotomy rates.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021293382, identifier: CRD42021293382.

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Section: Introductionmentioning

confidence: 99%

Episiotomy Practice and Its Associated Factors in Africa: A Systematic Review and Meta-Analysis

et al. 2022

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“…Previous studies reported an increased risk of severe perineal injuries when midline episiotomy was performed [26,28]. Recent recommendation of good obstetric practice encourages restrictive use of episiotomy instead of routine episiotomy [29,31]. A study conducted in the Netherlands evaluating the effect of mediolateral episiotomy on perineal integrity, underpinned how mediolateral episiotomy should be preferred for its sphincter-saving effect particularly on high-risk women, as nullipara [32].At our Institution mediolateral episiotomy is generally preferred to midline episiotomy.…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with severe perineal lacerations during vaginal delivery: a 10-year propensity score–matched observational study

Longo¹,

Odjidja²,

Zanfini³

et al. 2023

AJOG Global Reports

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“…Some authors proposed a specific informed consent for episiotomy, to prevent the litigation liability and claim of “obstetric violence”. For these reason, it is important a specific consent also for IU, particularly for UT [20] , [21] , [22] , [23] . Goli et al [22] discuss about the obstetric violence in the delivery room in India; they find that it is a more common reality among women from socially disadvantaged communities.…”

Section: Discussionmentioning

confidence: 99%

Intrapartum ultrasound and mother acceptance: A study with informed consent and questionnaire

Malvasi,

Damiani,

Edoardo

et al. 2023

European Journal of Obstetrics & Gynecology and Reproductiv

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Episiotomy: a medicolegal vicious cycle

Cited by 6 publications

References 43 publications

Episiotomy Practice and Its Associated Factors in Africa: A Systematic Review and Meta-Analysis

Episiotomy Practice and Its Associated Factors in Africa: A Systematic Review and Meta-Analysis

Risk factors associated with severe perineal lacerations during vaginal delivery: a 10-year propensity score–matched observational study

Intrapartum ultrasound and mother acceptance: A study with informed consent and questionnaire

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