© 1998 Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom
research-article |
Episiotomy and perineal tears in low-risk UK primigravidae
F. L. R. Williams, Lecturer
C. du V. Florey, Professor, Head of Department
G. J. Mires, Senior Lecturer, Consultant
S. A. Ogston, Lecturer
Department of Epidemiology and Public Health, University of Dundee, Ninewells Hospital and Medical School Dundee DD1 9SY
Department of Obstetrics and Gynaecology University of Dundee
Address correspondence to Dr Williams.
BACKGROUND: The aim of the study was to determine the rates and to describe the risk factors for episiotomy and perineal tears in low-risk primigravidae.
METHOD: A cross-sectional survey of 101 randomly selected NHS hospitals in the UK was carried out between February 1993 and January 1994. Subjects were 40 consecutive lowrisk primigravidae in each hospital. The main outcome measures were number and reasons for episiotomy, and number and degree of perineal tears.
RESULTS: A large proportion of women (83 per cent) experienced some form of perineal trauma. Forty per cent of the women had an episiotomy only, 6 per cent an episiotomy and perineal tear, and 37 per cent perineal or other tears without episiotomy. The main reasons for performing an episiotomy were foetal distress (27 per cent), impending tear (25 per cent) and delay of the second stage of labour (21 per cent). Fifty-nine per cent of women with a delayed second stage had a spontaneous vaginal delivery and 41 per cent required instrumental assistance. The likelihood of having an episiotomy increased with the duration of the second stage of labour, irrespective of type of delivery. Episiotomy rates varied appreciably throughout regions and hospitals in the United Kingdom, ranging from 26 to 67 per cent. There was also a large regional variation in the rates of perineal trauma; generally, high rates of one outcome were associated with low rates of the other. Compared with white women, women from the Indian sub-continent were almost twice as likely and those from the Orient almost five times as likely to have an episiotomy.
CONCLUSION: The magnitude of the geographical variation suggests a lack of uniformity in indications for performing episiotomies and that guidelines for performing episiotomies may need to be reviewed. The rates of episiotomy in women from the Indian sub-continent and Orient were very high compared with those for white women, and this requires clarification and explanation, as they are contrary to rates experienced in these ethnic groups in other countries.
Keywords: episiotomy, low-risk primigravidae, ethnicity, geographical variation