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166: Episiotomies: who does them and do they help?

      Objective

      To examine episiotomy rates in relation to obstetric provider characteristics and maternal and neonatal injury.

      Study Design

      We performed a retrospective database analysis of all deliveries at a tertiary care maternity hospital from November 2008 to June 2014. This quality improvement project was determined IRB exempt. Scheduled cesarean deliveries and deliveries without a documented attending physician were excluded. Maternal injury was defined as third degree and fourth degree lacerations, while neonatal injury was defined by ICD-9 designated birth injury codes. Vaginal deliveries were classified as spontaneous or assisted, which included failed and successful vacuum and forceps deliveries. Student t-test, chi-square and fisher's exact tests were used to evaluate demographic and clinical variables of mothers and neonates. Odds ratio were calculated using multiple logistic regression model after adjusting risk factors maternal BMI, birth weight, gestational age at birth, multiple gestation, diabetes, hypertension and assisted vaginal delivery. All statistical analyses were performed using SAS software version 9.3 (SAS Institute Inc., Cary, NC). A two-sided p-value<0.05 was considered statistically significant.

      Results

      A total of 35,164 deliveries occurred during the study interval, of which 26,857 mothers and 27,389 neonates were included. The overall episotomy rate was 6.43%. The cesarean delivery rate was 17.84%. Episiotomy rates were higher with increasing obstetric provider years in practice (p<0.0001, Table 1). However, the obstetric provider cesarean delivery rate did not decrease with years in practice nor did it correlate with episiotomy rates (Figure 1). Rates of maternal (OR=2.62, 95%CI: 2.17-3.16) and neonatal injury (OR=6.04, 95%CI: 3.36-10.87) were significantly higher when episiotomy was performed, even after controlling for risk factors.

      Conclusion

      Episiotomy rates were higher in physicians out in practice longer. Higher episiotomy rates did not correlate with lower maternal and birth injury nor did it correlate with lower cesarean rates.
      Figure thumbnail fx1
      Table 1: Demographic and clinical variables by episiotomy group
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      Figure 1: Regression analysis of the correlation between episiotomy rate and cesarean rate by individual provider (n=128; p=0.71).