Magnitude of Episiotomy and Associated Factors among Mothers Who Give Birth in Arba Minch General Hospital, Southern Ethiopia: Observation-Based Cross-Sectional Study

Abstract

Background. Episiotomy is the most common obstetric procedure, performed when the clinical circumstances place the patient at a high risk of high-degree laceration. However, episiotomy should be done with judicious indication to lower perineal laceration with fewer complications. Despite its adverse effects, the magnitude of episiotomy is increasing due to different factors. Therefore, this study is aimed at determining the recent magnitude of episiotomy and at identifying associated factors among women who gave delivery in Arba Minch General Hospital, Southern Ethiopia. Methods. An institution-based cross-sectional study was conducted from December 15, 2018, to January 30, 2019. A systematic random sampling technique was used to select study participants. A semistructured questionnaire was used to collect data. This was supplemented with a review of the labor and delivery records. Binary and multivariable logistic regression analyses were performed to identify factors associated with the magnitude of episiotomy. P value ≤ 0.05 was used to determine the level of statistically significant variables. Results. The magnitude of episiotomy was found to be 272 (68.0%) with 95%CI=64.0‐72.5. Women who attended secondary education [AOR=10.24, 95%CI=2.81‐37.34], women who attended college and above [AOR=4.61, 95%CI=1.27‐16.71], birth weight≥3000 g [AOR=4.84, 95%CI=2.66‐8.82], primipara [AOR=4.13, 95%CI=2.40‐7.12], being housewife occupants [AOR=3.43, 95%CI=1.20‐9.98], married women [AOR=2.86, 95%CI=1.40‐5.84], and body mass index<25 kg/m2 [AOR=2.85, 95%CI=1.50‐5.44] were independent variables found to have significant association with episiotomy. Conclusion. The magnitude of episiotomy was 68.0% which is higher than the recommended practice by WHO (10%). The study participants’ occupational status, marital status, educational status, parity, birth weight, and BMI were significantly associated with the magnitude of episiotomy in the study area. Therefore, to reduce the rate of episiotomy, it is better to have periodic training for birth attendants regarding the indication of episiotomy.

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

“…Out of 40,831 women, episiotomy was practiced on 15,437 of them. The highest prevalence of episiotomy practice was reported in a study from Uganda, at 73% ( 55 ), followed by Ethiopia, at 68% ( 64 ). On the contrary, the lowest rate of episiotomy, 9.3%, was reported in a study from Nigeria ( 40 ).…”

“…Eighteen primary studies employed an analytical cross-sectional study design, while the remaining three studies employed a descriptive cross-sectional study design. Regarding the settings in which the studies were conducted eight studies were conducted in Ethiopia ( 45 , 46 , 54 , 57 , 61 , 64 , 66 ), eight in Nigeria ( 40 – 42 , 58 , 63 , 65 , 82 ), and the remainder of the studies were conducted in the Democratic Republic of the Congo (DRC) ( 69 ), Zimbabwe ( 83 ), Uganda ( 55 ), Ghana ( 84 ), and Burkina Faso ( 85 ). The majority of the studies, 16 (76.2%), were reported from Eastern and Western African countries.…”

“…In this meta-analysis, 17 of the 21 studies reported a percentage of episiotomy practice in primiparous and multiparous women ( 40 – 42 , 45 , 46 , 53 , 54 , 56 – 58 , 61 , 63 – 66 , 69 , 83 ), while the other four studies did not ( 55 , 82 , 84 , 85 ). The mean age of the study participants was not reported in ~66.7% of the studies ( 40 , 46 , 55 , 56 , 58 , 63 , 64 , 66 , 69 , 82 – 84 ). Among the studies that reported the age of the study subjects, the mean age of women for whom episiotomy was performed was 25.57 years ( 41 , 45 , 53 , 54 , 57 , 61 , 85 ).…”

“…Regarding the sampling techniques and data collection tools, nine studies employed systematic random sampling methods ( 45 , 46 , 53 – 55 , 57 , 61 , 64 , 66 ), eleven studies employed either retrospective ( 40 – 42 , 56 , 58 , 63 , 65 , 82 – 84 ) or prospective ( 85 ) analysis of delivery notes, while the remaining one study employed stratified sampling methods ( 69 ). Furthermore, pre-tested questionnaires and refined checklists were used to collect data ( Supplementary File 5 ).…”

“…Episiotomy was most performed in central Africa 50 % [(95% CI: 47.74–52.26), I 2 = .%, P < 0.001] ( 69 ). East Africa came in second with 47.7% [(95% CI: 36.55–58.44), I 2 = 98.7 %, p < 0.001] ( 45 , 46 , 53 , 54 , 57 , 61 , 64 , 66 , 83 ). In western African countries, episiotomy was performed in 35.01% [(95% CI: 26.99–43.02), I 2 = 99.6%, p < 0.001] ( 40 – 42 , 56 , 58 , 63 , 65 , 82 , 84 , 85 ) of parturients.…”