Episiotomy incidence and decision-making factors: a prospective descriptive study at a maternity hospital in Vietnam

Episiotomy, a perineal incision performed to expand the birth canal and expedite labor, is typically done based on the birth attendant’s assessment. This study aimed to investigate the incidence of episiotomy in vaginal deliveries and to explore the factors that influence clinical decision-making at Hung Vuong Hospital. This prospective descriptive study included 384 vaginal delivery cases from labor onset to hospital discharge between March and May 2023. Data on medical history, pregnancy, labor, postpartum details, and neonatal outcomes were collected. Birth attendants were surveyed post-delivery regarding their decision-making. Descriptive statistics summarized participant characteristics. Univariate and multivariate logistic regression models were used to identify factors associated with episiotomy. Statistical analyses were performed using Stata 14, with significance set at p<0.05. Episiotomy was performed in 208 cases (54.2%). The most common reasons for conducting or avoiding episiotomy were perineal elasticity, parity, fetal condition, labor progression, and instrumental vaginal delivery. Episiotomy was strongly associated with a history of vaginal delivery (aOR 0.06; 95% confidence interval [CI] 0.03–0.10), full-term pregnancy (aOR 3.59; 95% CI 1.43–9.03), and deliveries attended by private doctors (aOR 2.38; 95% CI 1.23–4.60). No cases of obstetric anal sphincter injury (OASIS) were recorded. Maternal outcomes included a higher degree of perineal tear (aOR 219.61; 95% CI 81.03–595.20), while neonatal outcomes showed no significant differences (p>0.05). The incidence of episiotomy (54.2%) remained greater than the WHO-recommended rate of 10%. This study outlined the important factors driving episiotomy decisions, emphasizing the need for evidence-based, individualized practice.