Abstract
<title>Abstract</title> <p>Background Episiotomy is one of a commonly performed obstetric procedure, involving an incision made in the vaginal introitus during second stage of labor. This study aimed to assess episiotomy practice and associated maternal morbidities in the study setting. Methods This prospective, hospital-based, analytical cross-sectional study included 500 women who delivered vaginally at 37 weeks or more gestation and underwent a mediolateral episiotomy. Data were collected via structured questionnaires at three time points: initially on the day of delivery and subsequently at one week postpartum, then data regarding Long-term follow up were obtained through follow-up telephone interviews conducted three months postpartum. The Chi-square test was used to assess associations between categorical variables and the study outcomes, while multivariable logistic regression analysis was implemented to determine the predictors of those outcomes. Results Most of participants were primigravid women (77.6%), aged ≤ 35 years (86.4%), housewives (87.0%) and the vast majority delivered by spontaneous vaginal delivery (98.6%). The study setting demonstrated a high prevalence of episiotomy (82%). Nearly one-quarter (23.8%) of participants experienced complications. Pain was the most prevalent complication in both the acute (14.6%) and short-term (14.2%) phases. Other notable issues included extended episiotomy, bleeding, infection, and suture slippage (wound dehiscence). No long-term complications were reported. Several factors were strongly associated with an increased risk of complications: Older maternal age (> 35 years) were more than twice as likely (OR 2.185) to experience complications compared to younger women (15–25 years). Multiparous women were approximately nine times more likely (OR 9.069) to experience complications than primigravid women. A prolonged second stage of labor (≥ 2 hours) and the use of instrumental delivery were associated with a 100% complication rate in the study sample. Diabetes and the practice of anterior episiotomy (used in cases of Type III FGM) were linked to pain and bleeding respectively. Almost the entire cohort (98.6%) reported a history of Female Genital Mutilation, primarily Type II. Specific type of FGM significantly influenced acute and short-term outcomes. Conclusions The high frequency of episiotomies, paired with a substantial morbidity rate of nearly 25%, indicates that the procedure is likely being utilized as a routine practice rather than a clinically indicated procedure. Moreover, the data suggests that current obstetric management lacks the necessary nuance to adequately tailor delivery practices to the specific risk profiles of individual patients, highlighting an urgent need for evidence-based reform regarding episiotomy practice.</p>