Time trends in episiotomy and severe perineal tears in Portugal: a nationwide register-based study

BMC Pregnancy and Childbirth

Research

Elsa Lorthe¹  Henrique Barros²  Cristina Teixeira³ 

[1] EPIUnit - Instituto de Saúde Pública, Universidade Do Porto, Rua das Taipas nº135, 4050-600, Porto, Portugal;EPIUnit - Instituto de Saúde Pública, Universidade Do Porto, Rua das Taipas nº135, 4050-600, Porto, Portugal;Departamento de Ciências de Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade Do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal;EPIUnit - Instituto de Saúde Pública, Universidade Do Porto, Rua das Taipas nº135, 4050-600, Porto, Portugal;Instituto Politécnico de Bragança, Bragança, Campus de Santa Apolónia, 5300-253, Bragança, Portugal;

关键词: Severe perineal tears;    Episiotomy;    Time-trends;    Obstetric intervention;    Women’s health;   

DOI  :  10.1186/s12884-022-05314-6

 received in 2022-07-26, accepted in 2022-12-19,  发布年份 2022

来源: Springer

【 摘 要 】

IntroductionRates of episiotomy and severe perineal tears (SPT) are indicators of the quality of obstetric care. Time-trends in the reported occurrence of episiotomy and SPT can contribute to understand both, changes in care and in the frequency of risk factors. Therefore, we aimed to estimate time trends in the frequency of SPT in Portugal and its relationship with episiotomy.MethodsWe conducted a nationwide register-based study using data from the national inpatient database of all Portuguese public hospitals between 2000 and 2015. Time-trend analysis using joinpoint regression models was performed to identify trends (joinpoints) and compare time changes in the prevalence of SPT and risk factors expressed as annual percentage changes (APC) with 95% Confidence Intervals (95% CI). Poisson regression models were fitted to estimate whether time-trends in SPT rates were explained by changes in risk factors and to assess the association between episiotomy and SPT. Adjusted relative risk (aRR) and their respective 95% CI were obtained.ResultsFrom 908,999 singleton vaginal deliveries, 20.6% were instrumental deliveries, 76.7% with episiotomy and 0.56% were complicated by SPT. Among women with non-instrumental deliveries and no episiotomy SPT decreased from 2009 onwards (1.3% to 0.7%), whereas SPT kept increasing in women with episiotomy for both non-instrumental (0.1% in 2000 to 0.4% in 2015) and instrumental deliveries (0.7% in 2005 to 2.3% in 2015). Time-trends in potential risk factors did not explain the observed increase in SPT. Episiotomy was associated with a decrease in SPT with adjusted RR varying between 2000 and 2015 from 0.18 (95%CI:0.13–0.25) to 0.59 (95%CI:0.44–0.79) for non-instrumental deliveries and from 0.45 (95%CI:0.25–0.81) to 0.50 (95%CI:0.40–0.72) for instrumental deliveries.ConclusionsOur findings suggest that episiotomy rate could safely further decrease as the main factor driving SPT rates seems to be an increase in awareness and reporting of SPT particularly among women who underwent an episiotomy.

【 授权许可】

CC BY   
© The Author(s) 2022

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