Episiotomy Use in a Low-Income Setting: Prevalence, Associated Factors, and Maternal Outcomes Among Vaginal Births at a Tertiary Hospital in Ethiopia.

OBJECTIVE

To estimate episiotomy prevalence, identify independently associated factors, and describe maternal outcomes among vaginal births at a tertiary hospital in Ethiopia.

METHODS

We conducted a retrospective cross-sectional review of 306 sampled records of women with eligible vaginal births at Wolaita Sodo University Comprehensive Specialized Hospital from January 1 to February 28, 2023. Variables with a bivariable p < 0.25 were entered into a multivariable logistic regression model. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Perineal outcomes were compared by episiotomy status using unadjusted analyses.

RESULTS

Episiotomy was documented in 141 births (46.1%). Higher odds of episiotomy were associated with no documented antenatal care (AOR 1.98, 95% CI 1.10-3.57), second-stage duration of at least 1 h (AOR 2.70, 95% CI 1.52-4.81), postterm birth (AOR 9.73, 95% CI 1.92-49.16), and birth weight of at least 2500 g (AOR 3.46, 95% CI 1.25-9.57). Lower odds were associated with multiparity, documented comorbidity, preterm birth, and absence of meconium-stained amniotic fluid. Documented second-degree tears were more frequent among women with episiotomy than among those without it (22.7% versus 11.5%; unadjusted OR 2.26, 95% CI 1.21-4.19).

CONCLUSION

Episiotomy was common and associated with several measured maternal and intrapartum characteristics. Because the maternal-outcome comparison was unadjusted and susceptible to confounding by indication, it does not establish that episiotomy caused perineal injury. The findings support restrictive, protocol-based use and regular institutional audit.