Has the use of routine episiotomy decreased? Examination of episiotomy rates from 1983 to 2000

Obstetrics and GynecologyPublished 1 March 2002

Jay Goldberg

DOI10.1016/s0029-7844(01)01756-2

Source URL

Citations57

SJR quartileQ1

SJR score1.97

SNIP2.22

TL;DR

White women consistently underwent episiotomy more frequently than black women even when controlling for age, parity, insurance status, and operative vaginal delivery.

Abstract

There was a statistically significant reduction in the overall episiotomy rate between 1983 and 2000. White women consistently underwent episiotomy more frequently than black women even when controlling for age, parity, insurance status, and operative vaginal delivery.

Keywords

Medicine

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This article discusses extensions of generalized linear models for the analysis of longitudinal data in which heterogeneity in regression parameters is explicitly modelled and uses a generalized estimating equation approach to fit both classes of models for discrete and continuous outcomes.

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There is less posterior perineal trauma, less suturing and fewer complications, no difference for most pain measures and severe vaginal or perineAL trauma, but there was an increased risk of anterior perineals trauma with restrictive episiotomy.

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There is evidence that postpartum pain and discomfort are accentuated after episiotomy, and serious complications, including maternal death, can be associated with the procedure, so carefully designed controlled trials of benefit and risk should be carried out on the use of Episiotomy.

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428 Citations1984Jennifer Sleep, Adrian Grant +4 more

Findings provide little support either for liberal use of episiotomy or for claims that reduced use of the operation decreases postpartum morbidity.

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Obstetrical & Gynecological SurveyBenefits and Risks of Episiotomy

179 Citations1995Robert J. Woolley

The overall degree of risk that accompanies this procedure could only be justified by a clear and overriding benefit, which, as discussed under "Benefits" earlier in this review, does not appear to exist.

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It is concluded that the risks and benefits of midline episiotomy should be evaluated in a randomized clinical trial that compares policies of “usual” versus conservative use of episiotomies.

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Black primiparas were less likely to delivery with second-degree or greater lacerations and more likely to deliver with their perineums intact andMultivariable analysis showed that black women were twice as likely to Deliver with intact perineum than white women.

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Although differences in episiotomy rates mainly reflect clinical circumstances, important site-to-site variations and interspecialty differences point to potential areas where physician behaviors influence the performance of episiotome.

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