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[Indications for episiotomy at public maternity clinics in Nequen, Argentina] Rev Panam Salud Publica. 1998 Jul;4(1):26-31.

Auteur·e(s) :

Cravchik S, Munoz DM, Bortman M.

Année de publication :

1998

URL(s) :

http://hermia.ingentaselect.com/vl=4581285/cl=24/n…

Résumé (français)  :

Abstract (English)  :

Indications for performing episiotomy during vaginal births are a controversial topic requiring worldwide review. In Neuquen Province, Argentina, when standards for low-risk childbirth were developed in 1995, they included the provision to limit episiotomies to cases at high risk for spontaneous laceration. The present retrospective cohort study was designed for comparing the criteria applied in 1996 as indications for episiotomy in public maternity services of Neuquen Province, as well as the effect of parity and other variables on its frequency.

The Perinatal Data System yielded 7,513 medical records for review, which represented 70% of all the institutional births during the year. Of these records, 830 dealing with cesarean sections did not qualify for the study. The remaining 6,683 records were divided into eight groups according to hospital location.

Episiotomy incidence rates were estimated for those eight groups and the Poisson regression was applied in order to adjust for birthweight, number of siblings, mother’s age, and type of birth presentation and outcome. Taking the Neuquen Hospital data as baseline because of its higher complexity and large number of births taking place there, two hospitals had episiotomy incidence rates equal to 70% (95% CI: 62%-79%) and 67% (95% CI: 57%-78%) of the Neuquen Hospital rates. Two other hospitals had incidence rates which were higher by 28% (95% CI: 13%-45%) and 17% (95% CI: 2-35%), while the remaining hospitals showed no significant differences. Stratified regression by number of previous vaginal births showed parity to be the strongest influencing variable on indications for episiotomy. Rates for nulliparous women showed no differences by hospital, but rates for primiparous women did, with even stronger differences shown for multiparous women.

The authors concluded that all institutions included in the study performed episiotomies as a virtually routine procedure on nulliparous women, that there are significant differences in their indications for primiparous women, and that those differences increase along with parity. These differences seem to show that maternity clinics in the Province of Neuquen vary widely in their criteria for episiotomy indications.

Sumário (português)  :

Resumen (español)  :

Remarques :

Argument (français) :

Les maternités de la province de Neuquen (Argentine) ont des critères fortement divergents pour ce qui est de la pratique de l’épisiotomie.

Argument (English):

Argumento (português):

Argumento (español):

Mots-clés :

➡ médecine factuelle ; épisiotomie

Auteur·e de cette fiche :

Cécile Loup — 27 Apr 2004