Department of Obstetrics Gynecology and Neonatology, "Gr. T. Popa" University of Medicine and Pharmacy, Iasi, Romania.
Rationale, Aims, And Objectives: The aim of this study was to focus attention on episiotomy practice in Romanian maternity units in order to identify factors associated with the very high rate of the procedure in Romania and to consider strategies to reduce it.
Methods: In this clustered cross-sectional study, a total of 11 863 patients were recorded in eight Romanian maternity units to assess the prevalence of episiotomy. A random effects Poisson model was used to estimate the prevalence rate in univariate and multivariate models.
Results: Among the 11 863 patients included for analysis, 8475 (71.4%) had an episiotomy. The prevalence of episiotomy was 92.7% for the first vaginal birth, 73.2% for the second vaginal birth, and 35% for the third vaginal birth. The overall rate of suturing was higher than the episiotomy rate for all patients (total rate 79.2%). The likelihood of exiting the maternity ward with an intact perineum after the first vaginal birth was less than 5% at the first vaginal birth.
Conclusions: In conclusion, routine episiotomy is the norm in Romanian maternity units, with episiotomy rates among the highest in Europe. Episiotomy use is mainly driven by local professional norms, experiences, previous training, and practitioners' decisions rather than evidence, guidelines, or variations in patient needs at the time of vaginal birth.
Department of Obstetrics-Gynecology and Neonatology, "Carol Davila" University of Medicine and Pharmacy, Department of Obstetrics and Gynecology, "St. John" Emergency Clinical Hospital, Bucharest, Romania;
Department of Obstetrics-Gynecology and Neonatology, "Carol Davila" University of Medicine and Pharmacy, Department of Obstetrics and Gynecology, "Elias" Emergency Clinical Hospital, Bucharest, Romania;
aDepartment Obstetrics and Gynecology, Clinical University Emergency Hospital bDepartment of Obstetrics and Gynecology, "Sf Pantelimon" Clinical Emergency Hospital, "Carol Davila" University of Medicine and Pharmacy cDepartment of Hematology, Provita Medical Center dDepartment of Hematology, University Emergency Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
Carol Davila University of Medecine Department Obstetrics Gynecology Clinical Emergency Hospital Sf Pantelimon Bucharest, Romania.
The literature review was conducted to identify the causes of the rising incidence of caesarean section (CS) cases in Romania, and to create a database and a measurement plan to quantify the amount of CS on maternal request and the influence of geographical, social and economic factors. The review was conducted at the Department of Obstetrics and Gynaecology Clinical Emergency Hospital Sf Pantelimon, Bucharest, and comprised figures of clinical records of all patients who underwent CS between 2009 and 2014. The results showed an increase in the number of CS on maternal requests. In 2014 it reached a rate of 36.90 cases in every 100 newborn infants, which was 2.62% higher than 2013. Increasing rate of CS seemed to have resulted from a few factors, including the constant preoccupation to improve the obstetrical field in Romania; its services; the prophylactic measures in obstetrics; the trials to prevent the fear of the obstetrical malpraxis and its risks and consequences; and the fact that some obstetricians have done multiple CS deliveries on maternal requests.
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