Prof. Thomaz Gollop
Routine episiotomy should be abandoned
EDITORIn their editorial Maduma-Butshe et al discussed the need to
abandon the routine use of episiotomy in developing countries.1
View this table:
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Episiotomy rates in one hospital in Rosario, Argentina, before,
during, and after episiotomy trial.3 Values are percentages
(proportions)
The use of episiotomy is a paradigmatic example of the many
interventions that are introduced into clinical practice without
scientific evidence and found after well performed research to be not
only unjustified but also possibly harmful.2 In addition, once an
intervention has been established in clinical practice it is not easily
abandoned, even when strong scientific evidence shows its uselessness
and harmfulness.
We have presented the results of our study on episiotomy3 and the
reviews about it 2 4 many times, but clinicians have often remained
sceptical and expressed little desire for change.
The table shows the trend in the use of episiotomy in one of the
hospitals where the Argentine episiotomy trial was performed (Maternidad
Martin, Rosario, Argentina).3 Overall rates of episiotomy changed from
47.9% before the trial to 28.4% four years after completion of the
trial. However, the decrease in the rate of episiotomy was observed
predominately in multiparous women, with little change in nulliparous
women. During the trial nulliparous women had an episiotomy rate
of
39.5%, but rates in daily practice increased to 82%; four years after
the end of the study and an intense dissemination of the results, rates
were nearly double those obtained during the trial.
There is no obvious way to change a practice that has strong evidence
against it once the practice has been implemented. The challenge
is now
to look for and test strategies to obtain such a change for routine
episiotomy.
José M Belizán, Director.
Latin American Centre for Perinatology, Pan-American Health
Organisation-World Health Organisation, Montevideo, Uruguay
Guillermo Carroli, Director.
Centro Rosarino de Estudios Perinatales, Rosario, Argentina
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Jose Luis Quelho
CRMMS * TEGO
Aquidauana - MS
