The practice of episiotomy in public hospitals in Hong Kong.
OBJECTIVE
To review the use of episiotomy during vaginal delivery in Hong Kong public hospitals.


METHODS
Prospective observational survey.


METHODS
Public hospitals, Hong Kong.


METHODS
Women who underwent normal vaginal delivery of a singleton foetus with cephalic presentation.


METHODS
Number of women having an episiotomy, severe-degree (third- or fourth-degree) tear, other types of tear, blood loss at delivery, postpartum haemorrhage, need for blood transfusion, puerperal pyrexia, wound infection, gaping wound that required suture removal, and drainage or resuturing of a perineal wound.


RESULTS
Between 1 January and 31 March 2003, there were 6222 singleton spontaneous normal vaginal deliveries in the public hospitals of Hong Kong. Of the 6167 women in whom the status of the perineum was known, episiotomy was performed in 5274 (85.5%). Primiparous women were more likely to undergo episiotomy at delivery than multiparous women (97.9% vs 71.4%). Women with episiotomy had significantly less perineal tearing of any kind than those without. The occurrence of any type of perineal tear and severe-degree (third- or fourth-degree) tear was significantly lower in primiparous women who had an episiotomy than those without (P<0.05). Women with episiotomy had increased mean blood loss at delivery but other complications were not significantly increased.


CONCLUSIONS
In Hong Kong, episiotomy is routinely performed during normal vaginal delivery. It is associated with a significantly lower overall rate of perineal tearing. This study was observational, nonetheless the occurrence of other complications was likely to increase when episiotomy was performed. Firm evidence from several randomised controlled studies shows that routine episiotomy is unjustified and possibly harmful. Routine episiotomy should not be promoted in Hong Kong without further randomised controlled study.
Lam
K W
KW
Department of Obstetrics and Gynaecology, University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong. kawai7@hkucc.hku.hk
Wong
H S
HS
Pun
T C
TC
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D004841:Episiotomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000209:etiology; D010298:Parity; D010502:Perineum / Q000293:injuries; D010818:Practice Patterns, Physicians'; D011247:Pregnancy