The Philadelphia Episiotomy Intervention Study.
OBJECTIVE
To lower the episiotomy rate through physician education and documentation of indication when episiotomy was performed.


METHODS
The intervention consisted of an evidence-based lecture recommending limited usage of episiotomy and requesting documentation of any episiotomy's indication. Data 3 months prior to the intervention were compared to those of the year following. Adjusted comparisons of episiotomy rates were completed using multivariate logistic regression models.


RESULTS
For all vaginal deliveries, there was a 17% decrease in the rate of episiotomy, from 46.9% to 38.8%. For spontaneous vaginal deliveries, there was a 25% decrease in the episiotomy rate, from 40.8% to 30.8%. The most common indications for episiotomy reported were routine/elective, 41.0%; vacuum, 18.6%; forceps, 16.4%; and nonreassuring fetal heart tracing, 10.9%.


CONCLUSIONS
Episiotomy rates may be effectively reduced through physician education and documentation of procedure indication.
Goldberg
Jay
J
Department of Obstetrics and Gynecology, and Biostatistics Section, Division of Clinical Pharmacology, Jefferson Medical College, 834 Chestnut Street, Suite 400, Philadelphia, PA 19107, USA. jaygoldbergmd@yahoo.com
Purfield
Patricia
P
Roberts
Nancy
N
Lupinacci
Paul
P
Fagan
Matthew
M
Hyslop
Terry
T
D000328:Adult; D001724:Birth Weight; D036861:Delivery, Obstetric / Q000379:methods* / Q000706:statistics & numerical data; D004841:Episiotomy / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D006801:Humans; D016015:Logistic Models; D008423:Maternal Age; D015999:Multivariate Analysis; D009774:Obstetrics / Q000193:education* / Q000706:statistics & numerical data; D010298:Parity; D015143:Philadelphia; D010818:Practice Patterns, Physicians'; D011247:Pregnancy