Hernández-Martínez Antonio, Pascual-Pedreño Ana Isabel, Baño Garnés Ana Belén, Melero-Jiménez María del Rocio, Molina Alarcón Milagros
Servicio de Paritorio, Gerencia de Atención integrada de Alcázar de San Juan, Ciudad Real, España.
Servicio de Ginecología y Obstetricia, Gerencia de Atención integrada de Alcázar de San Juan, Ciudad Real, España.
Enferm Clin. 2014 Sep-Oct;24(5):269-75. doi: 10.1016/j.enfcli.2014.03.005. Epub 2014 Apr 29.
To determine the variability in the use of episiotomy among midwives and its relation to third and fourth-degree tears, and the impact on neonatal morbidity.
A study was conducted on historical groups from a total of 2,366 eutocic births with a single live fetus greater than or equal to 37 weeks gestation and 18 midwives over a three year period (2009, 2010 and 2011) in "Mancha-Centro" Hospital (Alcázar de San Juan).The outcomes variables for this analysis were the incidence of episiotomy, perineal lacerations, and neonatal morbidity.
The variability in the use of episiotomy ranged from 19.5% to 50.1% among the 18 midwives in the study, with an average rate of 34.9% (824). Grouped at intervals, 22.1% (524) had a rate of ≤25%, 26.1% (621) between 26-35%, 38% (898) between 36-44%, and 13.7% (323) a rate of ≥45%, with homogeneity between the groups for all the confounding factors. There was no statistical association between higher rates of episotomy and pH of umbilical artery<7.10, Apgar score after 5 min<7, and the level of neonatal resuscitation type iii and iv. There was also no relationship between the rate of episiotomy with perineal integrity and third and fourth-degree tears.
The variability in the rate of episiotomy is high, and it is not related to the increased presence of third and fourth-degree tears or increased neonatal morbidity. Episiotomy rates should not be greater than 25%, in order to prevent perineal trauma or loss of fetal well-being.
