Has the use of routine episiotomy decreased? Examination of episiotomy rates from 1983 to 2000

Jay Goldberg, David Holtz, Terry Hyslop, Jorge Tolosa

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

OBJECTIVE: To determine if practice patterns have been altered by the large body of literature strongly advocating the selective use of episiotomy. METHODS: An electronic audit of the medical procedures database at Thomas Jefferson University Hospital from 1983 to 2000 was completed. Univariate and multivariable models were computed using logistic regression models. RESULTS: Overall episiotomy rates in 34,048 vaginal births showed a significant reduction from 69.6% in 1983 to 19.4% in 2000. Significantly decreased risk of episiotomy was seen based upon year of childbirth (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.86, 0.87), black race (OR 0.29, 95% CI 0.28, 0.31), and spontaneous vaginal delivery (OR 0.40, 95% CI 0.36, 0.45). Increased association with episiotomy was seen in forceps deliveries (OR 4.04, 95% CI 3.46, 4.72), and with third- or fourth-degree lacerations (OR 4.87, 95% CI 4.38, 5.41). In deliveries with known insurance status, having Medicaid insurance was also associated with a decreased episiotomy risk (OR 0.59, 95% CI 0.54, 0.64). CONCLUSION: There was a statistically significant reduction in the overall episiotomy rate between 1983 and 2000. White women consistently underwent episiotomy more frequently than black women even when controlling for age, parity, insurance status, and operative vaginal delivery.

Original languageEnglish (US)
Pages (from-to)395-400
Number of pages6
JournalObstetrics and Gynecology
Volume99
Issue number3
DOIs
StatePublished - 2002
Externally publishedYes

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Episiotomy
Odds Ratio
Confidence Intervals
Insurance Coverage
Logistic Models
Medical Electronics
Medical Audit
Parturition
Lacerations
Medicaid
Parity
Insurance
Surgical Instruments
Databases

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Has the use of routine episiotomy decreased? Examination of episiotomy rates from 1983 to 2000. / Goldberg, Jay; Holtz, David; Hyslop, Terry; Tolosa, Jorge.

In: Obstetrics and Gynecology, Vol. 99, No. 3, 2002, p. 395-400.

Research output: Contribution to journalArticle

Goldberg, Jay ; Holtz, David ; Hyslop, Terry ; Tolosa, Jorge. / Has the use of routine episiotomy decreased? Examination of episiotomy rates from 1983 to 2000. In: Obstetrics and Gynecology. 2002 ; Vol. 99, No. 3. pp. 395-400.
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abstract = "OBJECTIVE: To determine if practice patterns have been altered by the large body of literature strongly advocating the selective use of episiotomy. METHODS: An electronic audit of the medical procedures database at Thomas Jefferson University Hospital from 1983 to 2000 was completed. Univariate and multivariable models were computed using logistic regression models. RESULTS: Overall episiotomy rates in 34,048 vaginal births showed a significant reduction from 69.6{\%} in 1983 to 19.4{\%} in 2000. Significantly decreased risk of episiotomy was seen based upon year of childbirth (odds ratio [OR] 0.87, 95{\%} confidence interval [CI] 0.86, 0.87), black race (OR 0.29, 95{\%} CI 0.28, 0.31), and spontaneous vaginal delivery (OR 0.40, 95{\%} CI 0.36, 0.45). Increased association with episiotomy was seen in forceps deliveries (OR 4.04, 95{\%} CI 3.46, 4.72), and with third- or fourth-degree lacerations (OR 4.87, 95{\%} CI 4.38, 5.41). In deliveries with known insurance status, having Medicaid insurance was also associated with a decreased episiotomy risk (OR 0.59, 95{\%} CI 0.54, 0.64). CONCLUSION: There was a statistically significant reduction in the overall episiotomy rate between 1983 and 2000. White women consistently underwent episiotomy more frequently than black women even when controlling for age, parity, insurance status, and operative vaginal delivery.",
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