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Episiotomy use among residents and faculty compared with private practitioners
Nancy L S Howden1, Anne M Weber, Leslie A Meyn
1University of Pittsburgh Health Sciences Center, Magee-Womens Hospital, Department of Obstetrics, Gynecology, and Reproductive Sciences, Pittsburgh, Pennsylvania 15213, USA. nhowden@mail.magee.edu
Obstetrics and Gynecology
|January 6, 2004
Summary
Episiotomy rates decreased over time but remained high, especially with private practitioners. Women seeing private physicians had a significantly higher risk of episiotomy compared to those with academic practitioners.
Area of Science:
- Obstetrics and Gynecology
- Surgical Procedures
Background:
- Episiotomy use has been a subject of debate, with evidence supporting restricted use.
- Understanding trends in episiotomy is crucial for evidence-based practice.
Purpose of the Study:
- To analyze trends in episiotomy utilization.
- To compare episiotomy rates among academic (residents, faculty) and private practitioners.
Main Methods:
- Retrospective review of delivery data from 1995-2000 at Magee-Womens Hospital.
- Analysis of spontaneous or operative vaginal deliveries of singleton, liveborn, vertex infants at >= 37 weeks gestation.
- Statistical analysis using Fisher exact test, chi2 test for linear trend, and logistic regression.
Main Results:
- Overall episiotomy rate was 54.8%, decreasing from 59.7% to 45.0% during the study period.
- Independent risk factors included advanced maternal age, white race, higher education, marriage, nulliparity, and prior cesarean delivery.
- Practitioner type was the strongest predictor; private physician patients had a 7-fold increased risk of episiotomy.
Conclusions:
- High episiotomy rates persist among private practitioners.
- This contrasts with evidence supporting restricted episiotomy use.
- Further investigation into practice variations is warranted.