ABSTRACT
SUMMARY OBJECTIVE: The main aim of this study was to assess the associated factors for selective mediolateral episiotomy at a tertiary, academic hospital. METHODS: A retrospective cohort analysis between 2017 and 2019 was performed. The primary outcome was the prevalence of selective mediolateral episiotomy. Independent variables were maternal, intrapartum, and neonatal characteristics. A significance level of 5% was established, and univariate and multivariate analyses with logistic regression models were performed. RESULTS: From 2,761 vaginal deliveries eligible for inclusion during this period, the prevalence of selective mediolateral episiotomy was 18.7%. Univariate analysis has shown that non-white women were protective factors (OR=0.77 [0.63-0.96]; p=0.02) for episiotomy; primiparity (OR=2.61 [2.12-3.21]; p<0.01), number of vaginal examinations between 6-10 repetitions (OR=3.16 [2.48-4.01]; p<0.01) and 11-20 repetitions (OR=5.40 [3.69-7.90]; p<0.01), longer second stage duration (OR=1.01 [1.00-1.02]; p<0.01), and women with gestational age more than 37 weeks were risk factors. Multivariate analysis reported that second stage duration (AOR=1.01 [1.00-1.03]; p<0.01), primiparity (AOR=2.03 [1.34-3.06]; p<0.01), and number of vaginal examinations between 6-10 repetitions (AOR=2.36 [1.50-3.70]; p<0.01) and 11-20 repetitions (AOR=3.29 [1.74-6.20]; p<0.01) were remained as risk factors for selective mediolateral episiotomy. CONCLUSION: A higher number of vaginal examinations during labor (over six repetitions), longer duration of second stage labor, and primiparity were risk factors associated with selective mediolateral episiotomy.
ABSTRACT
Background: Caesarean section at full dilatation with deeply engaged head in the pelvis can be associated with increased maternal and perinatal morbidity .The objective of present study is to compare the maternal and perinatal morbidity between the Patwardhan′s technique and the routine “push” and “pull” method for extraction of the fetus in second stage caesarean. Method: It is retrospective study including 100 cases of caesarean section performed for obstructed labor in between January 2017 to June 2018 in Obstetrics/Gynae Department,Mahatma Gandhi Memorial Medical College Hospital, Jamshedpur, Jharkhand. All the cases were divided into two groups: group A-where baby delivered by the Patwardhan′s technique and group B- where baby delivered by “push” and “pull” method. Maternal morbidity in terms of uterine extensions, PPH, need for blood transfusions as well as neonatal morbidity was compared between two techniques. Result: Review of 100 patients shows that there was significant low rates of maternal morbidity in terms of uterine incision extensions, and other related complications with Patwardhan′s technique. However there was no difference in neonatal outcome in both the groups. Conclusion: The Patwardhan′s technique is superior and quite safe method for delivery of baby in second stage cesarean sections and has minimal complications if anticipated and done skillfully