A nationwide cross-sectional survey of episiotomy practice in China

Background A restrictive use of episiotomy was recommended by the obstetric society in China, but limited information on the epidemiology and the effects of restrictive use of episiotomy on maternal and fetal outcomes have been published. Methods The China Labor and Delivery Survey is a cross-sectional investigation with a cluster random sampling scheme in 2015-2016 with the aim to describe detailed epidemiology of labor and delivery in China. We calculated the episiotomy rate by parity using the survey data. Associated factors of episiotomy were selected using mixed models with a random effect for the hospital-level clustering. Logistic regression models were fitted to examine the effects of mediolateral episiotomy on maternal and neonatal outcomes among the propensity score-matched women. Findings The episiotomy rate among vaginal births was 41.7% [95% confidence interval (CI): 40.1% - 43.2%] in nulliparae and 21.5% (95% CI: 19.4% - 23.5%) in multiparae in China. Associated factors of episiotomy included pre-pregnancy BMI, maternal diseases, and obstetric factors. More than half of episiotomies in nulliparae and one-fourth in multiparae had no indications. Mediolateral episiotomy without indicators increased the risk of 3rd or 4th degree perineal laceration [odds ratio (OR) =2.64, 95% CI: 1.08-6.48)] in nulliparae without neonatal benefits. Interpretation Episiotomy was performed more than medically necessary in China. Mediolateral episiotomy without indications more than doubled the risk of 3rd and 4th degree perineal laceration in nulliparae without neonatal benefits. Copyright (c) 2021 Published by Elsevier Ltd.