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 primigravida e, Method A cross-sectional survey of 101 randomly selected NHS hospitals in t he UK was carried out between February 1993 and January 1994. Subjects were 40 consecutive low-risk primigravidae in each hospital. The main outcome m easures were number and reasons for episiotomy, and number and degree of pe rineal 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 tea rs without episiotomy. The main reasons for performing an episiotomy were f oetal 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 req uired instrumental assistance. The likelihood of having an episiotomy incre ased with the duration of the second stage of labour, irrespective of type of delivery. Episiotomy rates varied appreciably throughout regions and hos pitals in the United Kingdom, ranging from 26 to 67 per cent. There was als o a large regional variation in the rates of perineal trauma; generally, hi gh rates of one outcome were associated with low rates of the other. Compar ed 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 f or 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.