Outcome of Episiotomy Repair by House Officers at the Niger Delta University Teaching Hospital, Nigeria

Main Article Content

Ikobho Ebenezer Howells
Isaac Joel Abasi

Abstract

Background: Episiotomy is the commonest operative procedures in obstetrics, and belied by many to expedite delivery. In most tertiary hospitals in Nigeria, majority of the episiotomies are repaired by house officer, with varying degree of complications.

Objective: To determine the complications of episiotomy repair by house officers, using repair by resident doctors as control. Specifically, it would evaluate the rate of wound dehiscence, perineal pain, estimated blood loss, acute urinary retention, vulva hematoma and dyspareunia.

Materials and Methods: A comparative study of 400 parturients who were admitted in labour, delivered vaginally, and had episiotomy repair at the Niger Delta University Teaching Hospital in Bayelsa State, Southern Nigeria. Episiotomy repair was carried out in the labour ward by house officers (200 subjects), and resident doctors (200 subjects). All the episiotomies were mediolateral and repaired with polyglactic acid suture, size 0. Using those repaired by resident doctors as control, assessment of the patients was carried within 24 hours for: perineal pain, acute urinary retention, delivery to repair interval, estimated blood loss and vulva hematoma. The next assessment was at 7 days postpartum for perineal pain and wound healing. Finally, they were evaluated at 6 weeks for complete wound healing, perineal pain, and dyspareunia.

Results: There was no significant difference in the rate of wound dehiscence between the 2 groups. However, episiotomy repair by house officers was associated with more vulva hematomas, Odds Ratio = 6.15[CI, 0.73 – 51.60], immediate postoperative pain, P = 0.04[CI, 0.71 – 1.06], and superficial dyspareunia.

Conclusion: Women whose episiotomies were repaired by house officers experience more postoperative morbidity than those repaired by resident doctors. If house officers will continue to repair most of the episiotomies, a more intensive training is recommended.

Keywords:
Episiotomy repair, house officers, resident doctors, outcome

Article Details

How to Cite
Howells, I. E., & Abasi, I. J. (2020). Outcome of Episiotomy Repair by House Officers at the Niger Delta University Teaching Hospital, Nigeria. International Journal of Research and Reports in Gynaecology, 3(2), 30-40. Retrieved from https://journalijrrgy.com/index.php/IJRRGY/article/view/30109
Section
Original Research Article

References

Bahtişen K, Aynur K, Pelin C, Gökçe D. Retrospective analysis of episiotomy prevalence. J Turk Ger Gynecol Assoc. 2017;18(4):190-4.

Alexander MF, Cande VA, Eri P, Mary ED, Jason DW, Mark PH, Jane D, Fergal DM. Variation in and factors associated with use of episiotomy. Journal of American Medical Association. 2015;313(2):197-9.

Olorunfemi OO, Akinbowale RE, Olayinka SI. Factors associated with episiotomy among parturients delivering in a tertiary care centre in Nigeria. International Journal of Research in Medical Sciences. 2015; 3(4):836-40.

Izuka EO, Dim CC, Chigbu CO, Obiora-Izuka. Prevance and predictors of episiotomy among women at first birth in Enugu, Southern Nigeria. Annals of Medical and Health Science Research. 2014;4(6):928-32.

Garba, Ozegya MS, Abuakar IS, Ayyuba R. Episiotomy in amino Kano Teaching Hospital, Kano, Nigeria. A 3-year review. Archives International Surgery. 2016;6(1): 17-21.

Chigbu B, Onwere S, Aluka C, Kamanu C, Adibe E. Factors influencing the us e of episiotomy my during g vaginal delivery in South Eastern Ntigeria. East African Medical Journal. 2008;85(5):240-3.

Barnabas TA, Isaac OA, David AO. Relative frequency and predictors of episiotomy in Ogbomoso, Nigeria. Internet Journal of Medical Update. 2012;7(2):42-5.

Okeke TC, Ugwu EOU, Okezie OA, Enwereji JO, Ezenuyeaku CCK, Ikeako CG. Trend and determinants of episiotomy at the University of Nigeria Teaching Hospiatl, Enugu, Nigeria. Nigerian Journal of Medicine. 2012;21(3):304-6.

Savithri Raman. Effectiveness of self perineal care and aseptic perineal care towards healing of episiotomy wounds among postnatal mothers. International Journal of Current Research and Academic Review. 2015;3(8):359-66.

Tammy K. Nyengidiki, Solomon Nyeche. Post-episiotomy morbidity amongst parturients at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. The Nigerian Health Journal. 2008;8(1):16-19.

Maryam A, Sedigheh A, Mohammad TS. Study of factors associated with postoperative pain following episiotomy in primiparous women at Mashhad Omalbanin Hospital. Journal of Midwifery and Reproductive Health. 2015;3(1): 305-14.

Hyacinth E. Onoh, Chris Akani. Rates and predictors of episiotomy in Nigerian women. Tropical Journal of Obstetrics and Gynaecology. 2004;21(1):44-5.

Bharathi A. Dharma Reddy DB, Sharath Kote. A prospective randomized comparative study of vicryl rapide vs chromic catgut for episiotomy repair. Journal of Clinical and Diagnostic Research. 2013;7(2):326-30.

Esa B, Meena S, Poonam L, Swati M, Arijit G. Comparison of impact of polyglactin 910 (Vicryl rapide) and chromic catgut sutureson perineal pain following episiotomy wound repair in eastern Indian patients. Journal of the Scientific Society. 2013;40(2):95-8.

Inyang-Etoh, Umoiyoho. The practice of episiotomy in a university teaching hospital in Nigeria: How satisfactory? International Journal of Medicine and Biomedical Research. 2012;1(1):68-72.

Abid MA, Li YW, Cummings CW, Bhatti NI. Patient outcomes as a measure of surgical technical skills: Does surgical competency matter? A systematic review. Otorinolaringologia. 2016;66(4):99-106.

Emmanuel C. Inyang-Etoh, Aniekan M. Abasiattai, Augustine V. Umoh. Outcome of episiotomy repair among women in a tertiary health care institution in Nigeria. Tropical Journal of Obstetrics and Gynaecology. 2014;31(2):57-61.

Bodner K, Bodner-Adler B, Wagenbichler P, Kaider A, Leodolter S, Husslein P, Mayerhofer K. Perineal lacerations during spontaneous vaginal delivery. Wien Klin Wochenschr. 2001;113(19):743-6.

Perumal D, Selvaraju D. Comparative study of episiotomy repair: Absorbable synthetic versus chromiccatgut suture material. Int J Reprod Contracept Obstet Gynecol. 2017;6(2):186-90.

Naseer M, Noreen H, Bilqis H, Sial SS. Short term outcome measures of chromic catgut versus vicryl rapide for episiotomy repair. J. Soc. Obstet. Gynaecol. Pak. 2018;8(4):212-7.

Rani, Shikha. Risk factors and incidence of puerperal genital haematomas. Journal of Clinical and Diagnostic Research. 2017; 11(5). DOI:10.7860/JCDR/2017/24060.9777

Cantekin İ, Hasan OT, Hakan T, Aslı O, Gonca G, Ayhan S, Nuri D. Evaluation of risk factors in women with puerperal genital hematomas. The Journal of Maternal-Fetal & Neonatal Medicine. 2016; 29(9):1435-9.

Practical bulletin: Prevention and Management of Obstetric Lacerations. The American College of Obstetricians and Gynecologists, Women’s Health Care Physicians. 2016;128(1):1-15.

Akpa and Oguntayo. Vulva hematoma. Archives of International Surgery. 2012; 2(1):37-8.

Latika Sahu. Vulval & Paravaginal Hematomas, Obstetrics & Gynecological Emergencies. Publisher: Jaypee, New Delhi. 1st Edition. 2011;10-11.

Ahmet E, Ahter TT, Gulhan S, Cetin K, Cigdem AY, Ilter Y. Management of puerperal vulvovaginal hematoma with different suture technique; case report. Medicine Science. 2017;6(3):579-81

Ridgway LE. Puerperal emergency: vaginal and vulva hematomas. Obstetrics and Genecology Clinic of North America. 1995;22:275–82.

Driessen M, Bouvier-Colle MH, Dupont C. Postpartum haemorrhage resulting from uterine atony after vaginal delivery: Factors associated with severity. Obstet Gynecol. 2011;117(1):21–31.

Manjula P, Ranjani PR, Anitha C. A study of factors influencing episiotomy wound healing. International Journal of Nursing Education. 2012;4(2):117-9.