Current trends in the utility of Episiotomy in a University Hospital, Benin City, Nigeria

Abstract

BACKGROUND: Episiotomies have been performed for several years for various indications. Routine use of episiotomy has gone into disfavor with many obstetricians and midwives in Europe and North America but many studies from Latin America, Asia and Africa continue to document prevalence of 50% or higher.

OBJECTIVE: This study sought to examine the current trend in the utilization of episiotomy in our hospital amidst an observation of increasing reports of episiotomy complications.

METHODS: The case records of women who delivered vaginally in the University of Benin Teaching Hospital, Benin City from January 2010 to December 2014 were retrospectively studied. Sociodemographic and clinical information were retrieved and analyzed.

Results: There were 5,398 women studied, among which 1,975 (36.6%) had episiotomy. Episiotomy was more likely in women younger than 30 years (60%), nulliparas (80.5%) and term pregnancies (94.2%). Midwives administered 82.0% of the episiotomies while consultants were involved in only 1.1%. Spontaneous vaginal delivery was 15.1% less likely to involve episiotomy than forceps, vacuum and breech deliveries together (35.6 vs 50.7%, RR 0.722 95%CI 0.608-0.856; P < 0.001). The 6-week appointment was kept by 40.1% (792) of the patients with 24.1% (191/792) reporting complications. Extension to the perineum occurred in 11.5% while episiotomy breakdown occurred in 8.4% of them.

Conclusion: Episiotomy remains widely utilized in our facility especially amongst young and nulliparous women with a considerable complication rate. A deliberate policy of selective episiotomy will probably improve the overall utility of the procedure.