4.2 Main findings
The overall episiotomy rate in Kasr Alainy was found to be 64%, which is higher than the rate recommended by the WHO (10%). The incidence in primigravid patients is 97%. Further research is necessary to discern the causes behind the elevated incidence among this patient group. Potential reasons include patient and practice related factors. Patient factors could include rigid perineum, prolonged second stage of labor, and other clinical indications, most commonly; instrumental deliveries, fetal distress, history or risk of OASIS (obstetric anal sphincter injuries), large fetus, and atypical presentations[16]. Practice related factors include the lack of time due to the hospital capacity being fully utilized, understaffing, high patient flow or hospital protocols. A study in China found the practice of episiotomy to be caused by previous training, the experience of practitioners and local norms rather than the latest medical evidence[17].
It was found that multigravida patients had an episiotomy incidence rate of 52%. Although this incidence rate is significantly lower than that of primigravid patients, it still exceeds the World Health Organization’s recommended rate of 10%. The factors examined among the multigravida patient sample were found to be statistically significant and clinically relevant. These findings suggest that the studied factors specifically influence the decision-making process regarding the performance of episiotomies in multigravida patients. Possible explanations for the incidence rate among multigravida patients being less than primigravid patients include; a decreased likelihood of having a rigid perineum, shorter labor durations, or variations in local norms and protocols.