TY - JOUR

T1 - Variations in rates of severe perineal tears and episiotomies in 20 European countries

T2 - a study based on routine national data in Euro-Peristat Project

AU - Blondel, Béatrice

AU - Alexander, Sophie

AU - Bjarnadóttir, Ragnheiður I.

AU - Gissler, Mika

AU - Langhoff-Roos, Jens

AU - Novak-Antolič, Živa

AU - Prunet, Caroline

AU - Zhang, Wei Hong

AU - Hindori-Mohangoo, Ashna D.

AU - Zeitlin, Jennifer

AU - Haidinger, Gerald

AU - Pavlou, Pavlos

AU - Velebil, Petr

AU - Andersen, Anne Marie Nybo

AU - Sakkeus, Luule

AU - Lack, Nicholas

AU - Antsaklis, Aris

AU - Berbik, István

AU - Ólafsdóttir, Helga Sól

AU - Bonham, Sheelagh

AU - Cuttini, Marina

AU - Misins, Janis

AU - Jaselioniene, Jone

AU - Wagener, Yolande

AU - Gatt, Miriam

AU - Nijhuis, Jan

AU - Klungsoyr, Kari

AU - Szamotulska, Katarzyna

AU - Barros, Henrique

AU - Horga, Mihai

AU - Cap, Jan

AU - Bolúmar, Francisco

AU - Gottvall, Karin

AU - Berrut, Sylvie

AU - Macfarlane, Alison

AU - the Euro-Peristat Scientific Committee

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Introduction: Rates of severe perineal tears and episiotomies are indicators of obstetrical quality of care, but their use for international comparisons is complicated by difficulties with accurate ascertainment of tears and uncertainties regarding the optimal rate of episiotomies. We compared rates of severe perineal tears and episiotomies in European countries and analysed the association between these two indicators. Material and methods: We used aggregate data from national routine statistics available in the Euro-Peristat project. We compared rates of severe (third- and fourth-degree) tears and episiotomies in 2010 by mode of vaginal delivery (n = 20 countries), and investigated time trends between 2004 and 2010 (n = 9 countries). Statistical associations were assessed with Spearman's ranked correlations (rho). Results: In 2010 in all vaginal deliveries, rates of severe tears ranged from 0.1% in Romania to 4.9% in Iceland, and rates of episiotomies from 3.7% in Denmark to 75.0% in Cyprus. A negative correlation between the rates of episiotomies and severe tears was observed in all deliveries (rho = −0.66; p = 0.001), instrumental deliveries (rho = −0.67; p = 0.002) and non-instrumental deliveries (rho = −0.72; p < 0.001). However there was no relation between time trends of these two indicators (rho = 0.43; p = 0.28). Conclusions: The large variations in severe tears and episiotomies and the negative association between these indicators in 2010 show the importance of improving the assessment and reporting of tears in each country, and evaluating the impact of low episiotomy rates on the perineum.

AB - Introduction: Rates of severe perineal tears and episiotomies are indicators of obstetrical quality of care, but their use for international comparisons is complicated by difficulties with accurate ascertainment of tears and uncertainties regarding the optimal rate of episiotomies. We compared rates of severe perineal tears and episiotomies in European countries and analysed the association between these two indicators. Material and methods: We used aggregate data from national routine statistics available in the Euro-Peristat project. We compared rates of severe (third- and fourth-degree) tears and episiotomies in 2010 by mode of vaginal delivery (n = 20 countries), and investigated time trends between 2004 and 2010 (n = 9 countries). Statistical associations were assessed with Spearman's ranked correlations (rho). Results: In 2010 in all vaginal deliveries, rates of severe tears ranged from 0.1% in Romania to 4.9% in Iceland, and rates of episiotomies from 3.7% in Denmark to 75.0% in Cyprus. A negative correlation between the rates of episiotomies and severe tears was observed in all deliveries (rho = −0.66; p = 0.001), instrumental deliveries (rho = −0.67; p = 0.002) and non-instrumental deliveries (rho = −0.72; p < 0.001). However there was no relation between time trends of these two indicators (rho = 0.43; p = 0.28). Conclusions: The large variations in severe tears and episiotomies and the negative association between these indicators in 2010 show the importance of improving the assessment and reporting of tears in each country, and evaluating the impact of low episiotomy rates on the perineum.

KW - anal canal

KW - episiotomy

KW - Europe

KW - injury

KW - international comparisons

KW - obstetric labor complications

KW - Perineum

KW - tears

KW - time trends

U2 - 10.1111/aogs.12894

DO - 10.1111/aogs.12894

M3 - Journal article

C2 - 26958827

AN - SCOPUS:84977071829

VL - 95

SP - 746

EP - 754

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

SN - 0001-6349

IS - 7

ER -