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.