Tayyaba Majeed, Fatima Waheed, Munazza Naheed, Sadaf Afzal, Zahid Mahmood.
The Changing Trends in Episiotomy in the Allied Teaching Hospitals of Rawalpindi Medical College.
Pak J Med Health Sci Jan ;12(2):595-7.

Aim: To evaluate the changing trends in episiotomies in patients giving birth by normal vaginal deliveries over last forty years. Design: Retrospective observational study. Settings: The study was conducted in three allied hospitals attached with Rawalpindi Medical College between 1967 and 2007. Method: A total of 180,106 patients were entered in the study. The data was analyzed and outcome measured in terms of frequency of normal vaginal deliveries with and without episiotomies and the change in frequencies on ten yearly basis. Results: After exclusion of cases, where data on mode of delivery was missing or women were delivered by Caesarean section, forceps or vacuum or through assisted breech delivery, a total of 124,798 cases were available for analysis. Among these women, 70506 (56.5%) were delivered normally and 54292(43.5%) had episiotomy during delivery. When data was analyzed according to parity, it was found that in all the Nulliparous women, 20% delivered through normal vaginal delivery and 80% received episiotomy during delivery. Upon analysis the vaginal delivery and episiotomy on ten yearly basis, following trends were seen. During the first ten years (1967 to 1976), 5593 women were delivered vaginally. Among these, 4012 (71.73%) had normal vaginal delivery and 1581 (28.26%) had episiotomy during delivery. During the second ten years (1976 to 1986), a total of 16763 women were delivered normally. Out of these, 11539 (68.83%) had normal vaginal delivery and 5224 (31.16%) had episiotomy during delivery. In the third ten years (1986 to 1996), 336 43 women were analyzed who had normal vaginal deliveries. Among this group, 20885 (62.07%) had normal vaginal delivery and 12758 (37.92%) had episiotomy. During the last ten years (1996 to 2007), 68799 women were analyzed who were delivered vaginally. Among this category, 34070 (49.52%) had normal vaginal delivery and 34729 (50.47%) had episiotomy during delivery. Conclusion: The episiotomy rate of 80% in primigravida cases is very high and above the international standards. The reasons for this very high rate need to be evaluated by another study. Majority of the deliveries are performed by junior doctors and it’s the training problem which needs to be addressed.

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