Nursing Care

Biography

Biography: MengQin Zhang

Abstract

Background: Since 1995, the WHO have restricted the liberal use of episiotomy, stating that restrictive episiotomy has a number of benefits.Despite of that, episiotomy is still the most common surgical procedure performed on women and the incidence of episiotomy reported internationally differs considerably. Most indications of episiotomy are not congruent with practice guidelines. The aim of the study was to identify incidence and indications of episiotomy in a certain tertiary hospital in Chengdu. Objectives: To assess the incidence of episiotomy and risk factors of mediolateral episiotomy during vaginal birth, to assist midwifves in identifying women who are at especially high risk for episiotomy,and to provide relative evidence to change episiotomy practice and reduce the episiotomy rate ultimately. Methods:A retrospective study was performed using data from the hospital-based birth registry system for 1624 normal vaginal singleton deliveries of a fetus in cephalic presentation at term without the use of vacuum extraction and forceps over a period of 6 months from January to June 2017.Multivariable logistic regressions were used to identify combinations of risk factors of episiotomy. Main outcome measures were episiotomy rates, odds ratios for risk factors: age, minority, parity, gestational ageï¹¥40 weeks, birthweight, transverse outlet(TO), biparietal diameter (BPD) and femur length(FL) of fetus, and some labour complications. Statistical analyses were performed using IBM SPPS Version 22.0. Results: The episiotomy incidence was 41.7% (677/1624), 50.4% (625/1240) for primiparas and 13.5% (52/384) for multiparas (p<0.001). Risk factors for episiotomy were birth weightï¹¥3500g(OR,1.39;95%CI,1.06-1.83;P=0.019), Gestational ageï¹¥40 weeks(OR,1.29;95%CI,1.03-1.62;P=0.029), BPD(OR,2.23;95%CI,1.53-3.25; p<0.001),maternal age(OR,1.04;95%CI,1.01-1.07;P=0.038). We found protective effects of multiparas(OR,0.13;95%CI,0.09-0.18;p<0.001)and large for TO(OR,0.52;95%CI,0.38-0.71; p<0.001). No significant difference were found in FL ,minority, and labour complications such as gestational diabetes mellitus(GDM), pregnancy-induced hypertension(PIH), heart disease in pregnancy. Conclusions: The episiotomy rates differed significantly in parity and BPD, indicating the misleading perceptions of prolonged second stage and large for fetal head. With reduction in episiotomy rates as a goal, we suggest that a focus group study is to explore midwives' reasons for performing episiotomies.