Perception of pain during episiotomy in a tertiary care centre in Sri Lanka

Senanayake, Hemantha; Adikaram, R; Alwis, Tyrone De; Ahmad, Mohammad Sharique; Gunathilaka, B B M J P

doi:10.4038/cmj.v56i1.2895

Cited by 4 publications

(6 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This audit showed that 21.0% episiotomies were performed without local analgesia. A previous Sri Lankan study has also demonstrated that women suffer from significant pain since a majority of episiotomies were performed without analgesia 1 . Main reason is that nurses and midwives involved in normal deliveries in Sri Lanka are not licensed to administer a local anaesthetic 1 and this needs to be addressed in a practical way.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A prospective clinical audit evaluating the incision angle at mediolateral episiotomy for vaginal delivery

Patabendige¹,

Gobi²,

Jayawardane

2020

Sri Lanka J Obstet & Gynae

View full text Add to dashboard Cite

Background: Increasingly, the angle at which the episiotomy is performed has come under scrutiny. The current recommendation is that because of distortion of the anatomy at crowning of the head, the incision should be at an angle of at least 60° from the midline to ensure that a post-delivery angle of 43° is achieved.Method: A prospective clinical audit was performed in Castle Street Hospital for Women, Colombo, Sri Lanka, evaluating the post-delivery angle after suturing of episiotomy in a sample of consecutive vaginally delivered women. The angle after repair was defined as the angle formed by the suture line and the midline is measured at the end of the suturing. OASI Care Bundle, recently developed by the RCOG was used as the gold standard reference.Results: A total of 105 consecutive vaginal deliveries with mediolateral episiotomy were evaluated. Mean age (SD) was 27.9 (6.0) years. Mean gestational age (SD) was 39.3 (1.7) and mean birthweight (SD) was 3.0 (0.5) kg. There were 97 (92.4%) spontaneous vaginal deliveries and 21 (20.0%) were diabetic. Majority, 48 (45.7%) had their first delivery. There were 6 (5.7%) third degree perineal tears and 24 (22.9%) had additional second degree perineal tears. Out of 105, 91 (86.7%) women had post-delivery angle of less than 45° and 33 (31.4%) of them were less than 30°. Only 14 (13.3%) episiotomies were having the correct post-delivery angle (45°). Majority (55.2%) had not been started from the midline. Conclusion:Current practice of incision angle at medio-lateral episiotomy is not satisfactory. Training using 'Episiotomy angle-cutter demonstrator' in the OASI Care Bundle has been planned before the re-audit.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Episiotomy is used almost routinely in vaginal deliveries in Sri Lanka 1 . However, it is indicated in certain situations including the instrumental vaginal deliveries and shoulder dystocia 2,3 .…”

Section: Introductionmentioning

confidence: 99%

A prospective clinical audit evaluating the incision angle at mediolateral episiotomy for vaginal delivery

Patabendige¹,

Gobi²,

Jayawardane

2020

Sri Lanka J Obstet & Gynae

View full text Add to dashboard Cite

show abstract

“…Since the current practice is routine episiotomy in most institutions [7,9], there is no added cost in implementing the intervention. Rather, it is an omission of a procedure already in place.…”

Section: Feasibilitymentioning

confidence: 99%

“…More importantly, recent evidence demonstrates more harm in the procedure than benefit [6]. In Sri Lanka, episiotomy is used almost routinely in vaginal deliveries without anaesthesia [7], despite the national recommendation to avoid routine episiotomy during spontaneous vaginal birth [8]. Many local studies confirm widespread use of routine episiotomy in the local setting.…”

Section: Introductionmentioning

confidence: 99%

Does routine episiotomy for vaginal births prevent major degree perineal tears? Summary of the evidence and its application to Sri Lanka.

Hewage¹,

Abeysena

Ziard

et al. 2018

J. Postgrad. Inst. Med.

View full text Add to dashboard Cite

An updated Cochrane Review concluded that in addition to increasing the risk of major perineal/vaginal trauma by 30%, routine episiotomy does not play a role in lowering the risk of many other outcomes including blood loss at delivery, perineal pain, delivering a nonasphyxiated baby or urinary incontinence at six months compared to selective episiotomy. This review evaluated 12 randomized controlled trials carried out on 6177 women from

show abstract

“…The current recommendation is that "routine" episiotomy should be abandoned. Limiting the use of episiotomy is strongly recommended to help protect the integrity of the perineum 2 . Until further research is done, episiotomy should be considered only for certain conditions like; assisted vaginal delivery (forceps or vacuum), preterm delivery, breech delivery, foetal compromise or predicted macrosomia.…”

Section: Introductionmentioning

confidence: 99%

Comparison of episiotomy rates, practice of analgesia and the maternal complications within first 24 hours at two tertiary care units: a comparative, descriptive and a retrospective study

Perera¹,

Fernando

2013

Sri Lanka J Obstet & Gynae

View full text Add to dashboard Cite

Objectives: Estimate the episiotomy rates at two tertiary care units. Find out the practice of analgesia, prior to performing the episiotomy at the two units. Find out the maternal complications within the first 24 hours after episiotomy at the two units. Compare the outcomes at the two units. Method: Data collected from medical records of all normal vaginal deliveries (NVD); from 21st April to 20th May 2011 at Anuradhapura Teaching Hospital (ATH) and 20th March to 20th May 2012 at labour room C, Castle Street Hospital for Women (CSHW). Results: The episiotomy rate at ATH was 59%, rate of 85% for primiparous women and a rate of 29.9% for multiparous women. The episiotomy rate at CSHW was 96.5%, a rate of 97.8% for primiparous women and a rate of 94% for multiparous women. All were medio-lateral episiotomies. Except for two women at CSHW who had epidural analgesia in labour, none of the other women had effective analgesia prior to performing episiotomies at both units. All women had 1%-2% lignocaine infiltrations prior to repair of episiotomy at both the above units. The complications documented within 24 hours due to episiotomy at both units were haematomas, re-suturing, vaginal pack insertions and anaemia. Conclusion: Episiotomy rate at CSHW was significantly higher than ATH. However at both units the episiotomy rates were higher than the recommended rates and there was no significant difference in the rate of complications at the two units.

show abstract

Perception of pain during episiotomy in a tertiary care centre in Sri Lanka

Cited by 4 publications

References 0 publications

A prospective clinical audit evaluating the incision angle at mediolateral episiotomy for vaginal delivery

A prospective clinical audit evaluating the incision angle at mediolateral episiotomy for vaginal delivery

Does routine episiotomy for vaginal births prevent major degree perineal tears? Summary of the evidence and its application to Sri Lanka.

Comparison of episiotomy rates, practice of analgesia and the maternal complications within first 24 hours at two tertiary care units: a comparative, descriptive and a retrospective study

Contact Info

Product

Resources

About