ArticleJournal of the colleges of medicine of South Africa2026
Restrictive approach to episiotomy and the risk of third- and fourth-grade perineal tears: An analytical cross-sectional study at a rural tertiary hospital in South Africa.
Article in Journal of the colleges of medicine of South Africa, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Based on current evidence, the World Health Organization (WHO) recommends a restrictive approach to episiotomy, rather than routine performance, with a rate of between 5% and 10%. This study aimed to ascertain the rate and conformity to the restrictive patterns of episiotomy among women delivering at Mthatha Regional Hospital (MRH). Methods: A cross-sectional analytical study was conducted with 400 participants at MRH between January and June 2022. Demographic and obstetric data were collected and analysed using SPSS software. Continuous data were analysed using the student's Results: The rate of episiotomy was 19% (74/400). The indications for episiotomy were macrosomia (8.1%), foetal distress during the second stage of labour (5.4%), delayed second stage of labour (5.4%), prolonged second stage (5.4%), previous C/S x2 in labour (2.7%), forceps delivery (2.7%) and tight perineum (1.3%); 74% (55/74) was undocumented. The factors associated with episiotomy were maternal age < 20 years (odds ratio [OR] 5.5, confidence interval [CI] 3.2-9.5) and primigravid status (OR 10.2, CI 5.2 - 19), Conclusion: The practice of episiotomy at MRH exceeds the recommendation by the WHO. Young maternal age and primigravid women were risk factors for episiotomy. Contribution: The low incidence of third- and fourth-degree tears among women without episiotomy reaffirms the advantages of a restrictive approach to the practice of episiotomy.
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