Prevalence and meta-analysis of episiotomy in the Middle East

Document Type : Review Article


1 PHD student of Reproductive Health, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Associate Professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3 Assistant Professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

4 PhD in Statistics, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

5 Assistant Professor, Department of Nursing, Amol School of Paramedical Sciences and Nursing, Mazandaran University of Medical Sciences, Amol, Iran.


Introduction: Routine use of episiotomy is not recommended for women giving birth naturally. However, several studies in the Middle East have reported that it has high prevalence, but there is no general estimate. This study was performed with aim to review the prevalence and met-analysis of episiotomy in the Middle East based on studies conducted in this field.
Methods: To search for articles, the databases of SID, Magiran, Medline, Science Direct, Scopus, Web of Science, Embase, ProQuest and google scholer search engines using the keywords of prevalence, epidemiology, frequency, incidence, rate and episiotomy in both languages of Persian and English and all possible combinations were searched with AND and OR operators. Calculation of heterogeneity of the studies was evaluated using I2 index and Bag test was used to examine the bias.
Results: Twelve articles with a sample size of 69171 were reviewed. The overall prevalence of episiotomy was 67% (95% CI: 55-78). Using the random effect model, the risk of episiotomy in primiparous women was two times than multiparous women, which was statistically significant (RR = 2.01, 95% CI: 0.87-4.63, p <0.001; I2 = 99.99). Oxytocin use was also associated with an 80% (60-95%) prevalence of episiotomy.
Conclusion: Due to the high rate of episiotomy in the Middle East, despite the standard set by the World Health Organization, there is an urgent need for planning to reduce this rate. Therefore, it is recommended to use effective methods to reduce the need for episiotomy in primiparous women and to avoid unnecessary clinical interventions such as using oxytocin.


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