Factors associated with episiotomy practice in Bukavu, Democratic Republic of the Congo

Ntamulenga Innocent, Mulongo Mbarambara Philémon, Imani Prince, Yatoka Justine, Mukanire Ntakwinja, Nyakiyo Olivier, Mukwege Denis


Background: The primary objective of the present study is to determine the episiotomy rate and factors associated with practice of episiotomy at the maternities in Bukavu town, South-Kivu, DRC.

Methods: A case-control study was carried out the women who underwent the episiotomy (case) and those which did not undergo episiotomy (control) over one 12 months period between January to December 2015. A total of 1878 women had a vaginal delivery at a rate of one case for one control (939 cases and 939 controls) were included. Their medical files were exploited. The factors associated with episiotomy were performed by logistic regression.

Results: The rate of episiotomy was 20.4%. It was found that after the logistic regression, the Primiparity (OR = 4,5;95% CI:2,31-4,49), the existence of a foetal distress (OR = 4,2;IC to 95% CI :2,36-5,29), the antecedent of episiotomy (OR = 3,9;95% CI:2,83-7,07), private character of maternity (OR= 3,3; 95% CI :2,12-6,30) and the fact that the childbirth was directed by a doctor (OR = 2,3; 95% CI :1,85-5,08) were strongly associated with the practice of the episiotomy in our medium of study.

Conclusions: This study showed UA-S/D ratio and UA-RI>2SD are significant predictors of perinatal deaths and immediate neonatal resuscitation in preeclampsia. Acute fetal distress in labour or neonatal nursery admission could not be predicted.


DRC, Episiotomy, Factors associated

Full Text:



Jovanovic N, Kocijancic D, Terzic M. Current approach to episiotomy: Inevitable or unnecessary? Open Medicine. 2011;6(6):685-90.

Graham ID, Carroli G, Davies C, Medves JM. Episiotomy rates around the world: an update. Birth. 2015;32(3):219-23.

Bansal RK, Tan WM, Ecker JL, Bishop JT, Kilpatrick SJ. Is there a benefit to episiotomy at spontaneous vaginal delivery? A natural experiment. Am J Obstet Gynecol. 1996;175(4),897-901.

World Health Organization. Care in normal birth: a practical guide. Geneve: WHO; 1996.

Carroli G, Mignini L. Episiotomía para el parto vaginal (Revisión Cochrane traducida). Cochrane Database of Systematic Reviews. 2012;11: CD000081.

Bakkali MEL, Azzouzi Y, Khadmaoui A, Ouaaziz NA, Arfaoui A. Risk factors associated with the practice of episiotomy and the occurrence of perineal tears in mothers at the maternity hospital of Chérif Idrissi hospital in the region of Gharb Chrarda Bni Hssen (Morocco). Int J Inno App Stu. 2014;7(3):911-9.

Marai W. A two years retrospective review of episiotomy at Jimma Teaching Hospital, southwestern Ethiopia. Ethiop Med J. 2002;40 (2):141-8.

Diniz SG, Chacham AS. “The cut above” and “the cut below”: the abuse of caesareans and episiotomy in Sao Paulo, Brazil. Reprod Health Matters. 2004;12:100-10.

Argentine Episiotomy Trial Collaborative Group. Routine versus selective episiotomy: a randomised controlled trial. Lancet. 1993;342:1517-8.

Jander C, Lyrenas S. Third and fourth degree perineal tears. Acta Obstet Gynecol Scand. 2001;80 (3):229-34.

Clesse C, Lighezzolo-Alnot J, Hamlin S, De Lavergne S, Scheffler M. The practice of episiotomy in France 10 years after the CNGOF recommendations: what state of the art? Gynecol Obstet Fertil. 2016;44(4):232-8.

Yemane Y, Sahile E, Alehegn A, Girma A, Robles C, Kebedde S et al. Assessment of the proportion and associated factors of episiotomy at public health institutions of Axum Town, Tigray Region, North Ethiopia, 2015. Crit Care Obstet Gynecol. 2017;3:11.

Belloo O, Anorlu AI. Episiotomies in Nigeria: should their use be restricted? Niger Postgrad Med J. 2002;99:13-6.

Liljestrand J. Episiotomy for vaginal birth: RHL commentary (last revised: 20 October 2003). The WHO Reproductive Health Library; Geneva: World Health Organization.

Izuka E, Prevalence and predictors of episiotomy among women at first birth in enugu South East Nigeria. Ann Med Health Sci Res. 2014;4:928.

Hueston WJ. Applegate JA, Mansfield CJ, King DE, McClaffin RR. Practice variations between family physicians and obstetricians in the management of low risk pregnancies. J Fam Pract. 1995;40(4):345-51.

Raisanen S, Vehvila¨inen-Julkunen K, Heinonen S. Need for and consequences of episiotomy in vaginal birth: a critical approach. Midwifery. 2010;26:348-56.

Alayande BT, Amole IO, Akin D. Relative frequency and predictors of episiotomy in Ogbomoso, Nigeria. Int J Med. 2012;7:2.

Mitiku G ,Beyene W, Geremew M. Assessment of Episiotomy Practice in Mizan-Aman General Hospital, Ethiopia. J Health Med Nursing. 2015;20:12-20.

Riesco LG, Costa ASC, Almeida SFS, Basile AL de O, Oliveira SMJV. Episiotomy, laceration and perineal integrity in normal births: analysis of associated factors. Rev enferm UERJ [Internet]. 2011;19(1):77-83.

Al-Ghammari K. Predictors of routine episiotomy in primigravida. Applied Nursing Res. 2016;29:131-5.

Leeman L, Fullilove AM, Borders N, Manocchio R, Albers LL, Rogers RG. Postpartum perineal pain in a low episiotomy setting: association with severity of genital trauma, labor care, and birth variables. Birth. 2009;36:283-8.

Eason E, Feldman P. Much ado about a little cut: is episiotomy worthwhile? Obstet Gynecol 2000; 95:616-8.

Nancy L.S. Howden, Anne M. Weber, Leslie A Meyn. Episiotomy use among residents and faculty compared with private practitioners. Obstetrics and Gynecol. 2004;103:114-8.

Faruel-Fosse H, Vendittelli F. Can we reduce the episiotomy rate? J Gynecol Obstet Biol Reprod (Paris). 2006;35(1):1S68-76.