Publication:

Risk factors for episiotomy among primiparous women in Madagascar: a retrospective case-control study

Background Episiotomy remains one of the most frequently performed obstetric procedures worldwide, especially among primiparous women. Despite recommendations promoting restrictive use, the practice remains common in low-resource settings. This study aimed to identify factors associated with episiotomy among primiparous women delivering at the University Hospital of Gynecology and Obstetrics of Befelatanana, Madagascar.

Methods A retrospective case-control study was conducted at the University Hospital of Gynecology and Obstetrics of Befelatanana from January 2018 to December 2019. Primiparous women who underwent vaginal delivery were included. Cases were women who received episiotomy and controls were women without episiotomy. Data were collected from medical records and analyzed using Epi Info and Microsoft Excel. Odds ratios (OR) with 95% confidence intervals (CI) were calculated.

Results Among 2,903 primiparous women, the prevalence of episiotomy was 34.51%. A total of 855 cases and 1,710 controls were analyzed. Factors significantly associated with episiotomy were maternal age ≥35 years (OR=2.90; 95% CI: 1.89-4.02), uterine height ≥34 cm (OR=1.48; 95% CI: 1.25-1.76), gestational age >42 weeks (OR=4.10; 95% CI: 1.81-20.39), labor duration ≥12 hours (OR=9.03; 95% CI: 7.48-10.89), prolonged second stage of labor, breech presentation (OR=4.04; 95% CI: 1.51-10.80), instrumental delivery, occipito-sacral delivery, and birth weight >3500 g.

Conclusions Episiotomy prevalence among primiparous women remains high in Madagascar. Restrictive use of episiotomy, improved intrapartum monitoring, and enhanced antenatal preparation may reduce unnecessary procedures and maternal morbidity.