Episiotomy Practice in China

Background: A restrictive use of episiotomy was recommended by the obstetric society in China, but limited information has been published on the episiotomy practice at a country level. While midline episiotomy has been demonstrated as a risk factor for 3 rd or 4 th degree lacerations, the effects of mediolateral episiotomy (the more common type) in China, remain unclear. Methods: The China Labor and Delivery Survey is a cross-sectional investigation with a cluster random sampling scheme in 2015-2016. We calculated the episiotomy rate by parity at national and regional levels. 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 “normal” women. Findings: The episiotomy rate 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 prepregnancy 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 3 rd or 4 th 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 medical necessary in China. Mediolateral episiotomy without indications more than doubled the risk of 3 rd and 4 th degree perineal laceration in nulliparae without neonatal benefits. Funding: The project was supported by National Natural Science Foundation of China (81273091) and Shanghai Health Commission Programme (GWIV-26.2). Declaration of Interest: The authors declare that they have no competing interests. Ethical Approval: The study protocol was approved by the Research Project Review Panel of the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction at the Department of Reproductive Health and Research of WHO, and the WHO Research Ethics Review Committee, Geneva, Switzerland, and the ethics committees at the Xinhua Hospital and all participating centers.