Episiotomy and perineal tears in low-risk UK primigravidae.

BACKGROUND: The aim of the study was to determine the rates and to describe the risk factors for episiotomy and perineal tears in low-risk primigravidae. METHOD: A cross-sectional survey of 101 randomly selected NHS hospitals in the UK was carried out between February 1993 and January 1994. Subjects were 40 consecutive low-risk primigravidae in each hospital. The main outcome measures were number and reasons for episiotomy, and number and degree of perineal tears. RESULTS: A large proportion of women (83 per cent) experienced some form of perineal trauma. Forty per cent of the women had an episiotomy only, 6 per cent an episiotomy and perineal tear, and 37 per cent perineal or other tears without episiotomy. The main reasons for performing an episiotomy were foetal distress (27 per cent), impending tear (25 per cent) and delay of the second stage of labour (21 per cent). Fifty-nine per cent of women with a delayed second stage had a spontaneous vaginal delivery and 41 per cent required instrumental assistance. The likelihood of having an episiotomy increased with the duration of the second stage of labour, irrespective of type of delivery. Episiotomy rates varied appreciably throughout regions and hospitals in the United Kingdom, ranging from 26 to 67 per cent. There was also a large regional variation in the rates of perineal trauma; generally, high rates of one outcome were associated with low rates of the other. Compared with white women, women from the Indian sub-continent were almost twice as likely and those from the Orient almost five times as likely to have an episiotomy. CONCLUSIONS: The magnitude of the geographical variation suggests a lack of uniformity in indications for performing episiotomies and that guidelines for performing episiotomies may need to be reviewed. The rates of episiotomy in women from the Indian sub-continent and Orient were very high compared with those for white women, and this requires clarification and explanation, as they are contrary to rates experienced in these ethnic groups in other countries.

National study of health and growth: respiratory symptoms and height in primary schoolchildren.

An analysis of the relationship between the height of primary schoolchildren in England and Scotland and their respiratory symptoms as reported by their parents showed that children with morning cough, day and night cough, wheeze and asthma or bronchitis in the preceding 12 months were shorter than those without these symptoms. In subsequent analyses account was taken of differences in social and biological factors as measured by father's social class, sibship size and parent's height. The relationship between height and asthma remained statistically significant. Morning cough and day and night cough were related to short stature in children living in more deprived conditions. The number of respiratory symptoms was inversely related to height but once the children with asthma were excluded from the analysis the trend tended to disappear. There was also some evidence that children with respiratory symptoms gained less height in a year than those without. Our results indicate that, with the exception of asthma, the association between respiratory symptoms and height in primary school children is only marginal. Nevertheless in lower social classes and where sibling size is large common respiratory symptoms are related to short stature.

Hyperglycaemia; a risk factor for hypertension.

The epidemiological evidence for an association between diabetes mellitus and ischaemic heart disease is reviewed briefly. The relationship between blood sugar after challenge and blood pressure is described, with particular reference to studies in populations of U.S. and Jamaican adults and Dutch children.