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Justification and education lower episiotomy rates: clinical intervention.(Obstetrics)
SANTIAGO, CHILE -- Education of obstetricians about risks associated with routine episiotomy and a requirement to justify use of the procedure significantly lowered episiotomy rates at two suburban Philadelphia hospitals
"Rates for episiotomies in the United States in general are still above 30%, indicating doctors are still cutting too many episiotomies," Dr. Jay Goldberg said at the FIGO World Congress of Gynecology and Obstetrics.
Generally the risks outweigh the benefits for performing a routine episiotomy. Common adverse effects include recto-vaginal fistulas and fecal incontinence. Overall, episiotomy rates have decreased in the United States from 1983 to 2000 (Obstet. Gynecol. 99[3]:395-400, 2002).
But some obstetricians still continue to routinely perform an episiotomy in many of their patients, said Dr. Goldberg, director of gynecology in the division of general obstetrics and gynecology at Thomas Jefferson University Hospital in Philadelphia.
About 5% of all deliveries at that hospital include an episiotomy. Therefore, Dr. Goldberg and his colleagues studied two Philadelphia community hospitals with episiotomy rates above the national average. The institutions--Bryn Mawr Hospital and Paoli Hospital--were identified through the Philadelphia Department of Public Health records.
Baseline data on 642 total vaginal deliveries and 510 spontaneous vaginal deliveries at the two hospitals were collected from August to October 2002. In November 2002, Dr. Goldberg and his colleagues performed an intervention. Obstetriciansattended an evidence-based lecture about the risks of unnecessary episiotomies and received follow-up educational materials via the mail. An episiotomy indication template was added to the GE Medical Systems Quantitative Sentinel electronic medical ...
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Source: HighBeam Research, Justification and education lower episiotomy rates: clinical...