title: Pattern of episiotomy use & its immediate complications among vaginal deliveries in 18 tertiary care hospitals in India.
abstract: OBJECTIVE
  In developed countries, efforts have been made to restrict episiotomy practice. However, in developing countries the episiotomy rates continue to be high. This study was conducted to evaluate the pattern of episiotomy use and its immediate complications among women delivering at tertiary level public hospitals in India.
  
  
  METHODS
  Prospective data of all women undergoing vaginal delivery including instrumental delivery were collected daily from the labour room registers of the 18 tertiary care hospitals on a structured proforma. Weekly data from all sites were sent to a central unit for compilation and analysis. Odds ratio was used to compare the proportion of genital trauma among women with and without episiotomy both in nulliparous and multiparous women.
  
  
  RESULTS
  Among 1,20,243 vaginal deliveries, episiotomy was performed in 63.4 per cent (n=76,305) cases. Nulliparaous women were 8.8 times more likely to undergo episiotomy than multiparous women. The various genital tract injuries reported were first degree perineal tear (n=4805, 3.9%), second degree perineal tear (n=1082, 0.9%), third and fourth degree perineal tear (n=186, 0.2%), anterior vaginal trauma requiring suturing (n=490, 0.4%), extension of episiotomy/vaginal laceration/excessive bleeding from episiotomy or tear (n=177, 0.15%), vulval/vaginal haematoma (n=70, 0.06%) and cervical tear (n=108, 0.08%). The combined rate of third and fourth degree perineal tears was observed to be significantly lower (p<0.001) among nullipara who received episiotomy (0.13%) compared to those who delivered without episiotomy (0.62%).
  
  
  CONCLUSIONS
  Significantly lower rates of third or fourth degree perineal tear were seen among nulliparous women undergoing episiotomy. The risk and benefit of episiotomy and its complications need to be evaluated through randomized clinical trials in the Indian context.
authors.affiliation: Division of Reproductive Biology & Maternal Health, Indian Council of Medical Research, New Delhi, India.
authors.forename: Shalini
authors.initials: S
authors.lastname: Singh
authors.affiliation: Division of Reproductive Biology & Maternal Health, Indian Council of Medical Research, New Delhi, India.
authors.forename: Tushita
authors.initials: T
authors.lastname: Thakur
authors.affiliation: Division of Reproductive Biology & Maternal Health, Indian Council of Medical Research, New Delhi, India.
authors.forename: Nomita
authors.initials: N
authors.lastname: Chandhiok
authors.affiliation: Division of Reproductive Biology & Maternal Health, Indian Council of Medical Research, New Delhi, India.
authors.forename: Balwan Singh
authors.initials: BS
authors.lastname: Dhillon
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000009:adverse effects*; D004841:Episiotomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007194:India; D007744:Obstetric Labor Complications / Q000503:physiopathology*; D010298:Parity / Q000502:physiology; D011247:Pregnancy; D012307:Risk Factors; D062606:Tertiary Care Centers; D014621:Vagina / Q000473:pathology / Q000601:surgery*