Prevalence of episiotomy practice and factors associated with it in Ethiopia, systematic review and meta-analysis

Abstract

An episiotomy is one of the most commonly performed obstetrics surgeries indicated in emergencies during the second stage of labor like fetal distress, dystocia, and tight perineum. As a result, this systematic review and meta-analysis aimed to assess the prevalence of episiotomy practice and associated factors in Ethiopia. Ten cross-sectional studies with a total population of 3718 were included in this study. The search was done using online databases like PubMed, HINARI, Web of Science, other gray, and online repositories of Universities. All the included papers were extracted and appraised using the standard extraction sheet format of JOANNA Briggs Institute. The Cochran Q-test and I² statistics test were used to test the heterogeneity of studies. To detect the publication bias of the included studies, a funnel plot and Egger's test were used. The pooled prevalence of episiotomy practice and the odds ratio with a 95% confidence interval were presented using forest plots. The overall pooled prevalence of episiotomy practice was 45.11% (95% CI; 37.04-53.18; I² = 96.3%). Prolonged second stage of labor (OR: 4.79, 95% CI: 3.03, 7.57), face presentation (OR: 4.26, 95% CI: 1.21, 15.07), birth weight > 4000 g (OR: 6.71, 95% CI: 3.14-14.33), instrumental delivery (OR: 4.26, 95% CI 2.95, 6.14), and primiparity (OR: 3.70, 95% CI: 1.90, 7.2) were factors associated with episiotomy practice. The overall prevalence of episiotomy practice was higher in Ethiopia compared to studies conducted in other countries. The prolonged second stage of labor, face presentation, birth weight > 4000 g, instrumental delivery, and primiparity of women were the factors associated with episiotomy practice. Therefore, efforts should be made to prevent routine episiotomy practice through creating awareness, adjusting national guidelines, affecting the World Health Organization episiotomy policy, and monitoring the activities of the health care facilities in executing the protocols.

Keywords: Ethiopia; episiotomy; indications; meta-analysis; obstetrics surgeries; systematic review.

Figure 1.

PRISMA flow chart of study selection for systematic review and meta-analysis of the practice of episiotomy and associated factors in Ethiopia.

Figure 2.

Forest plot of prevalence of episiotomy practice with corresponding 95% CIs of ten studies. The midpoint and the length of each segment indicated the prevalence of episiotomy practice and 95% CI. The diamond shape showed the pooled prevalence of all studies.

Figure 3.

Funnel plot test for publication bias for episiotomy practice in Ethiopia.

Figure 4.

Forest plot of the subgroup analysis based on the region of Ethiopia. SNNPR: Southern nation nationality and people’s region. Weights and between-subgroup heterogeneity tests are from the random-effects model.