Dissertation for obtaining the degree of Doctor of General Medicine
Title: Investigating the rate and causes of episiotomy in Yazidi and Al-Zahra Hospital, Qom in 2013
Authors: Dr. Ruqieh Ahangari - Bahare Karimi Hasnijeh
Abstract:
Introduction:
Given the complications such as infection, pain, hematoma, 3rd and 4th degree tears and that it seems that performing episiotomy in natural births, especially in primiparous women, is more than acceptable, this realization was carried out with the aim of investigating the extent and causes of performing episiotomy in natural births in two hospitals. Al-Zahra and Izadi of Qom were conducted on 700 people who referred to these two centers.
Methodology:
This study was conducted in a cross-sectional way for 750 people who gave birth naturally in these two maternity hospitals. that a questionnaire was completed for each person, that the first part of the questionnaire related to the patient's information and It was her delivery, and the second part was completed by the agent or performer of the delivery. 550 questionnaires were completed in the Yazidi maternity hospital and 150 questionnaires were completed in the Al-Zahra maternity hospital.
Findings:
Note that the use of episiotomy has decreased in the last 25 years, but our statistics in Qom was 62.4%, and the reasons for performing an episiotomy were none of the indications accepted and proposed by the articles, and more The episiotomies performed were due to the fear of consequences and personal experiences and with a much smaller proportion of what was learned during the student period, which shows that the high rate of episiotomies in Qom maternity hospitals has no scientific basis and has become more of a matter of taste for the person giving birth.
Results:
Out of 700 deliveries (62/4) 437 deliveries were performed with episiotomy and 263 deliveries were performed without episiotomy, with a statistical comparison between the two maternity hospitals, the rate of episiotomy was 61.1% in Nizdi maternity hospital and 67.3% in Al-Zahra maternity hospital. And according to the statistical comparisons between the average weight of the baby, the work experience of the midwife, the time of episiotomy, and the side of the person performing the delivery in the two groups. No significant differences were seen.
However, there is a significant difference between the average number of births in the two groups. A lower number of births increases the amount of episiotomy and also the reasons for performing an episiotomy:
There is a significant difference between the fear of the consequences of not performing an episiotomy and performing an episiotomy
Between personal experience, midwives and performing Episiotomy is a significant difference 0.0001p<
There is a significant difference between performing an episiotomy and what was learned during the student period.
And according to the studies, between performing an episiotomy and other factors such as vacuum delivery, reducing the delivery time, breech delivery[E1], shoulder distention, delivery in the posterior occiput position - reducing the fetal time Distress - the second stage of labor is long, the presence of a perineal valve lesion, the absence of a doctor, the lack of time and a sufficient number of personnel could not be performed.
Given that during the last 25 years of use, episiotomy has decreased, but our statistics in Qom was 62.4%, and the factors for performing episiotomy were none of the indications accepted and proposed by the articles, and most of the episiotomy performed due to Fear of consequences and personal experiences, and with a much smaller proportion of what was learned during the student period, which shows that the high rate of episiotomy in Qom maternity hospitals has no scientific basis and has become more of a matter of taste for the person giving birth.
Key words: episiotomy/natural birth
Introduction
Episiotomy is an incision in the perineum in order to increase the diameter of the pelvic outlet. Some experts believe that an episiotomy incision heals better than an accidental vaginal tear. At the same time, this method may cause complications in some women, including infection, pain, hematoma, 3rd and 4th degree tears.
In the past, episiotomy was routinely recommended in nulliparous women due to the reduction of the possibility of severe laceration of the perineum and complications due to relaxation of pelvic floor muscles and faster recovery. But in more recent controlled studies, they showed that episiotomy is not a successful method in reaching the mentioned goals. However, episiotomy is still routinely performed in the majority of medical and even educational centers in our country in first and second births. And in another study in Yemen, this rate was 75%.
Between 1980-1998, the number of episiotomies performed in the United States decreased from 2 million to 1.2 million (30% decrease). The biggest decrease was in 1990, which is attributed to obvious complications such as bleeding, pain during labor, the possibility of infection, and the occurrence of 3rd and 4th degree tears. Nowadays, many centers are less willing to give an episiotomy by using the Rietgen maneuver to control the perineum and prefer the rupture to happen by itself rather than performing an episiotomy, because the tears are usually smaller than the episiotomy, and its repair and recovery are easier and faster. On the other hand, the episiotomy incision may extend to the pelvic floor muscles, in addition to the longer recovery time and more painful than tearing. Episiotomy during childbirth is associated with short and long-term problems in women, including the pain and discomfort of the episiotomy area, which interferes with the interaction between mother and baby, breastfeeding, sexual relations, and even the mother's feeling of recovery after pregnancy, and urinary and fecal incontinence. These problems are less in women with a healthy vagina. Strong evidence in the form of clinical trials supports the limited use of episiotomy. In the past, it was believed that the use of episiotomy has advantages such as shortening the length of the second stage of labor (if the condition of the mother and the fetus is compromised), facilitating the use of vacuum and forceps, preventing damage to the brain stem as a result of the fragility of the brain capillaries of preterm babies, facilitating the birth of a macrosomic fetus (larger than 4 kg) and showing breech. Despite this new research, it does not support the claim that episiotomy reduces brain bleeding (in preterm babies) and the length of the second stage of labor (1).
It has also been seen in studies that delivery without episiotomy leads to a decrease in the frequency of posterior perineal tears and it is better to deliver without episiotomy selectively and not for all primiparous women (2).
According to the mentioned complications and considering that it seems that episiotomy is still routinely performed in Yazidi Hospital, a study is needed to investigate the extent of episiotomy and the reasons for its use in this medical center in order to provide a suitable solution to reduce the use and limit the use of this method only in necessary cases.
Research objectives:
A. The main objectives of the project:
Determining the rate and causes of episiotomy in natural births in Yazidi and Al-Zahra hospitals in 1390
C- Assumptions - questions:
Frequency of episiotomy in natural births in Yazidi and How much is Al-Zahra according to her work history as an episiotomy operator
Chapter Two
Knowledge available in the research
Part I: conceptual framework
Clinical course of natural delivery:
The average duration of pregnancy is 280 days (9 months) from Lmp or 266 days from the time of conception, and delivery usually occurs at the end of this time.