Factors influencing the use of episiotomy during vaginal delivery in South Eastern Nigeria.

BACKGROUND Given considerable evidence that routine episiotomy increases maternal morbidity and without evidence to support maternal or neonatal benefit, has episiotomy use changed among health care providers? To date, very limited information exists relating to the past and current practice of episiotomy in many developing countries. OBJECTIVE To determine the prevalence of episiotomy at Aba in South Eastern Nigeria, examine factors influencing the performance of episiotomy and document complications associated with the procedure. DESIGN A hospital based retrospective study. SETTING The Abia State University Teaching Hospital (ABSUTH), Aba in South Eastern Nigeria, from January 2001 to December 2005. SUBJECTS Four thousand, one hundred and seventy two mothers who delivered vaginally within the study period. RESULTS There were 1877 episiotomies, for an episiotomy rate of 45%. Ninety per cent of the primigravid parturients had episiotomy. Women undergoing episiotomy were younger (mean age 24.7 years; range 16-37) than women without episiotomy (mean age 28.5 years, range 20-43). When controlled for parity and maternal age, other risk factors were occipito-posterior position, vacuum extraction, forceps delivery, vaginal breech delivery, and a history of Caesarean section. Episiotomy use was also associated with major perineal lacerations and increased length of hospital stay. CONCLUSION The episiotomy rate of 45 per 100 vaginal deliveries in this study is obviously higher than evidence-based recommendations for optimal patient care. A policy of systematic reduction in the incidence of episiotomy can be pursued in this hospital. Greater attention needs to be paid to selection of women to undergo episiotomy.