Episiotomy practice in six Palestinian hospitals: a population-based cohort study among singleton vaginal births.

Autor:	Zimmo K; Department of Obstetrics, Al Aqsa Hospital, Gaza, Palestine.; The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway., Laine K; Department of Obstetrics, Oslo University Hospital, Oslo, Norway.; Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway., Fosse E; The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Zimmo M; The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Department of Obstetrics, Al Shifa Hospital, Gaza, Palestine., Ali-Masri H; The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Department of Obstetrics, Palestine Medical Complex, Ramallah, Palestine., Zucknick M; Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway., Vikanes Å; The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway., Hassan S; Department of Nursing, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, Palestine.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2018 Jul 16; Vol. 8 (7), pp. e021629. Date of Electronic Publication: 2018 Jul 16.
DOI:	10.1136/bmjopen-2018-021629
Abstrakt:	Objective: To explore the rates, characteristics and indications for episiotomy among women delivering vaginally for the first time, as well as parous women. Study Design: A prospective, population-based birth cohort study. Setting: Obstetric departments in six Palestinian government hospitals. Participants: All women with singleton vaginal births (n=29 165) from 1 March 2015 until 1 March 2016. Methods: All women were divided into two groups: first vaginal birth group (n=9108), including primiparous women and women with their first vaginal birth after one caesarean section, and the parous group (n=20 057). Each group was analysed separately. Data were presented as numbers and percentages or range. Differences in rates were assessed by the p values of χ 2 test, or Fisher's exact test if there are cell counts less than 5. Main Outcome Measures: Episiotomy rates and indications among women of singleton births. Results: The overall episiotomy rate was 28.7%: 78.8% for women with first vaginal birth (range 56.6%-86.0%) and 5.9% for parous women (range 1.0%-9.5%). The most common indications for episiotomy were 'primiparity' in the first vaginal birth group (69.9%) and 'protecting the perineum' in the parous group (59.5%). The least common indications were prolonged second stage (1.5%) and fetal distress (6.9%), respectively. Conclusion: In Palestine, the majority of women who delivered vaginally for the first time had an episiotomy. Education of birth attendants, clinical audits, educational interventions and adherence to the updated guidelines may help to decrease the routine overuse of episiotomy. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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