1 Introduction
Episiotomy is a surgical incision in the perineum, performed during the
second stage of labor[1]. It was first described in 1742 and has
become a common means of preventing maternal injury and improving
neonatal outcome[2].
In recent years, however, there has been no credible evidence to support
the routine use of episiotomy; on the contrary, some studies have found
significant associated risks[2]. Reported complications include;
infection, hemorrhage and hematoma, skin tags and asymmetry, accidental
extension to the anal sphincter leading to fecal incontinence, and
rectovaginal fistulas. Additionally, delay in resumption of sexual
activity and dyspareunia are not uncommon[3]. In 2004, a study in
Munich concluded that avoiding episiotomy at tears presumed to be
imminent, reduces postpartum perineal pain without any complications or
adverse effects inflicted upon the mother or fetus[5].
Following the publicity of such evidence, in 1999, the Cochrane Database
Systematic Reviews recommended restrictive use of episiotomy[2], in
2006 the American College of Obstetricians and Gynecologists recommended
against routine episiotomy[4], and the WHO recommended an episiotomy
rate of 10% for all normal deliveries[3].
It is suggested to perform an episiotomy in deliveries with atypical
fetal presentations, including breech and shoulder dystocia, with
instrumental deliveries, in patients with scars or poorly healed tears
in the lower genital tract, and in cases of fetal distress[3].
Currently, in Egypt, there are limited epidemiological studies regarding
the practice of episiotomy. It appears, however, that in the Middle East
and North Africa, episiotomy is generally performed at higher rates than
the WHO recommendation.
This study aims to determine the incidence of episiotomy in patients
undergoing a vaginal delivery in Kasr Alainy OBGYN University Hospital
between March 1st, 2022, and June 30th, 2022. The objectives of this
study are to identify factors that influence the incidence of
episiotomy, outline any correlations, and address gaps in knowledge
The study was conducted in Kasr Alainy University Hospital, the largest
hospital in Egypt, with 5500 beds, servicing more than two million
patients annually[9]. It is considered by many a leading healthcare
provider and medical education center in the Middle East and Africa.