[Variability in the rate of episiotomies and its relation to severe perineal tears and neonatal morbility].
OBJECTIVE
To determine the variability in the use of episiotomy among midwives and its relation to third and fourth-degree tears, and the impact on neonatal morbidity.


METHODS
A study was conducted on historical groups from a total of 2,366 eutocic births with a single live fetus greater than or equal to 37 weeks gestation and 18 midwives over a three year period (2009, 2010 and 2011) in "Mancha-Centro" Hospital (Alcázar de San Juan).The outcomes variables for this analysis were the incidence of episiotomy, perineal lacerations, and neonatal morbidity.


RESULTS
The variability in the use of episiotomy ranged from 19.5% to 50.1% among the 18 midwives in the study, with an average rate of 34.9% (824). Grouped at intervals, 22.1% (524) had a rate of ≤25%, 26.1% (621) between 26-35%, 38% (898) between 36-44%, and 13.7% (323) a rate of ≥45%, with homogeneity between the groups for all the confounding factors. There was no statistical association between higher rates of episotomy and pH of umbilical artery<7.10, Apgar score after 5 min<7, and the level of neonatal resuscitation type iii and iv. There was also no relationship between the rate of episiotomy with perineal integrity and third and fourth-degree tears.


CONCLUSIONS
The variability in the rate of episiotomy is high, and it is not related to the increased presence of third and fourth-degree tears or increased neonatal morbidity. Episiotomy rates should not be greater than 25%, in order to prevent perineal trauma or loss of fetal well-being.
Servicio de Paritorio, Gerencia de Atención integrada de Alcázar de San Juan, Ciudad Real, España. Electronic address: antomatron@gmail.com.
Antonio
A
Hernández-Martínez
Servicio de Ginecología y Obstetricia, Gerencia de Atención integrada de Alcázar de San Juan, Ciudad Real, España.
Ana Isabel
AI
Pascual-Pedreño
Servicio de Paritorio, Gerencia de Atención integrada de Alcázar de San Juan, Ciudad Real, España.
Ana Belén
AB
Baño Garnés
Servicio de Paritorio, Gerencia de Atención integrada de Alcázar de San Juan, Ciudad Real, España.
María del Rocio
Mdel R
Melero-Jiménez
Universidad de Castilla-La Mancha, Albacete, España.
Milagros
M
Molina Alarcón
D000328:Adult; D015331:Cohort Studies; D004841:Episiotomy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008880:Midwifery; D010502:Perineum / Q000293:injuries*; D057184:Practice Patterns, Nurses'; D012189:Retrospective Studies; D055815:Young Adult
Desgarro perineal; Episiotomy; Episiotomía; Matrona; Midwife; Morbilidad neonatal; Neonatal morbidity; Perineal lacerations; Variabilidad; Variability