Episiotomy at a tertiary hospital in South-South, Nigeria: A 3-year review
Obodo DU1, Makinde OI1, Ozori ES1*
1Department of Obstetrics and Gynaecology, Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria.
*Correspondence: Dr. Ebiogbo S. Ozori; +234 8065876000; E-mail: firstname.lastname@example.org
Download full article in pdf format
Background: Routine episiotomy during the second stage of labour is no longer recommended. Instead, the World Health Organisation (WHO) recommends an episiotomy rate of 10 % of spontaneous vaginal deliveries. Assessment of hospital episiotomy practice is necessary to meet WHO recommendation.
Objectives: To determine episiotomy rate, the pattern of use of episiotomy in parturients, to make an evidence-based recommendation on the use of episiotomy and to provide a background for related studies at the Federal Medical Centre, Yenagoa.
Materials and Methods: This is a 3-year retrospective descriptive study of vaginal deliveries at Federal Medical Centre, Yenagoa, from 1st January 2015 to 31st December 2017. Relevant data were extracted from the labour ward register, including parity, gestational age at delivery, administration of episiotomy, state of perineum after delivery and birth weight. Analysis was done using IBM SPSS version 20.0. Frequencies and percentages of categorical variables are presented in tables.
Results: Of 2,347 women who had vaginal delivery during the study period, 210 had episiotomy, giving an episiotomy rate of 8.9 %. All the episiotomies were medio-lateral. Fifty-one (25.9%), 158 (8.2%) and 1 (0.4%) of nulliparous, multiparous and grandmultiparous women respectively had episiotomy. Episiotomy was given in 47 (31.8 %) and 206 (10 %) of parturients with macrosomic babies (birth weight ≥ 4kg) and term babies respectively and in 4 (1.3%) of parturients with preterm babies. Perineal tear rate was 26.3%; limited to 1st and 2nd degree tears.
Conclusion: The episiotomy rate at the Federal Medical Centre, Yenagoa is much lower than rates recorded in other hospitals in Nigeria. More episiotomies were performed in nulliparous women and during delivery of macrosomic babies. Low episiotomy rate may result in more perineal tears; however, it can achieve a low overall incidence of perineal trauma without an increased incidence of 3rd and 4th degree perineal tears.
Keywords: Episiotomy, Perineal tear, Episiotomy rate, medio-lateral episiotomy, Midline episiotomy, J-shaped episiotomy.
Cite this article: Obodo DU, Makinde OI, Ozori ES. Episiotomy at a tertiary hospital in South-South, Nigeria: A 3-year review. Yen Med J. 2021;3(3):166–171.
- Triah AT, Khambalia A, Ampt A, Moris JM, Roberts CL. Episiotomy rate in Vietnamese-born women in Australia: Support for a change in Obstetric practice in Vietnam. Bull World Health Organ. 2013; 91:350-356.
- Sule ST, Shittu SO. Pueperal complications of episiotomies at Ahmadu Bello University Teaching hospital, Zaria, Nigeria. East Afr Med J. 2003; 80:351-356.
- Baker PN. Operative intervention in obstetrics. In: Baker PN, ed. Obstetrics by Ten Teachers. 18th London: Hodder Arnold; 2006:255-272.
- Deirdre JM. Operative delivery. In: Kenny LC, Myers JE, eds. Obstetrics by Ten Teachers. 20th Boca Raton, FL: CRC press; 2017:473-475.
- Kwawukume EY, Samba A. Episiotomy and third-degree tear. In: Kwawukume EY, Emuveyan EE, eds. Comprehensive Obstetrics in the Tropics. Dansoman, Ghana: Ashante and Hittscher Printing Press Ltd.; 2002:352-355.
- Okeke TC, Ugwu EO, Okezie OA, Enwereji JO, Ezenyeaku CC, Ikeako LC. Trends and determinants of episiotomy at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Niger J Med. 2012;21:304-307.
- Aziken ME, Orhue AA, Onakewhor JU, Onuh S. Observation on the rates, benefits and complications of episiotomy in a tertiary health institution in Nigeria. Ann Biomed Sa. 2002;1:141-147.
- Sule ST, Shittu SO. Puerperal complications of episiotomies at Ahmadu Bello University Teaching Hospital Zaria, Nigeria. East Afr Med J. 2003;80:351-356.
- Gaba I, Ozegya MS, Abubakar IS, Ayyuba R. Episiotomy at Amino Kano Teaching hospital, Kano, Nigeria: A 3-year Review. Arch Int Surg. 2016;6:17-21.
- Konar H. Operative Obstetrics. In: Konar H, ed. DC Dutta Textbook of Obstetrics. 7th London: New Central book Agency (p) Ltd; 2011:563-598.
- Shahraki AD, Aram S, Pour Kabirians, Khodae S, coupannejed S. Comparison between early maternal and neonatal complications of restrictive episiotomy and routine episiotomy in primiparous vaginal delivery. J Res Med Sci. 2011;16:1583-1589.
- Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database sys Rev. 2009;CD000081.
- Beckman MM, Garrelt AJ. Atenatal Perineal massage for reducing perineal trauma. Cochrane Database sys Rev. 2006;CD005128.
- Aasheim V, Nilsen ABV, Reinar LM, Lukasse M. Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Syst Rev. 2017;6(6):CD006672.
- Morhe ES, Senghetsi S, Danso KA. Episiotomy in Ghana. Int J Gynecol Obstet. 2004; 86:46-47.
- Alayande BT, Amole IO, Akin D. Relative frequency and predictors of episiotomy in Ogbomoso, Nigeria. Intern J Med Update. 2012;7:41-44.
- Eyindah CE, Fiebai PO, Anya SE, Okpani AO. Episiotomy and perineal trauma prevalence and Obstetric risk factors in Port Harcourt, Nigeria. Niger J Med. 2007;16:242-245.
- Ola ER, Bellon O, Abudu OO, Anorlu RI. Episiotomies in Nigeria- Should their use be restricted? Post grad Med J. 2002;9:13-16.
- Kropp N, Hartwell T, Althabe F. Episiotomy rates from eleven developing countries. Int J Gynecol Obstet. 2005;91:157-159.
- Tidy C. Episiotomy and tears. Patient. Available from: https://patient.info/doctor/episiotomy-and-tears. Updated April 16, 2014. Accessed May 17, 2021.
- Goh R, Goh D, Ellepola H. Perineal tears – A review. Aust J Gen Pract. 2018;47(1-2):35-38.
- Bhattacharjee R. Episiotomy Vs Perineal Tear –A Comparative Study Of Maternal and Fetal Outcome. IOSR J Dent Med Sci. 2014;13(11):8-11.