Table_4_Episiotomy Practice and Its Associated Factors in Africa: A Systematic Review and Meta-Analysis.DOCX

BackgroundEpisiotomy, a surgical procedure that enlarges the vaginal opening during childbirth, was common practice until the early 2000s. Other sources, including the World Health Organization (WHO), advocate for the selective use of episiotomy. Episiotomy rates, on the other hand, have remained high in developing countries, while declining in developed countries. As a result, the current study sought to determine the overall prevalence of episiotomy in Africa as well as the risk factors associated with its practice.MethodsArticles were searched in international electronic databases. A standardized Microsoft Excel spreadsheet and STATA software version 14 were used for data extraction and analysis, respectively. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was used to write this report. A random-effects meta-analysis model was used to determine the pooled prevalence of episiotomy. A heterogeneity test was conducted using I-Squared (I2) statistics. Egger's test and funnel plots were conducted to detect publication bias. Subgroup analysis was also conducted. Association was expressed through a pooled odds ratio (OR) with a 95% Confidence Interval (CI).ResultA total of 21 studies with 40,831 participants were included in the systematic review and meta-analysis. The pooled prevalence of episiotomy practice was 41.7% [95% CI (36.0–47.4), I2 = 99.3%, P < 0.001). Primiparity [OR: 6.796 (95% CI (4.862–9.498)), P < 0.001, I2: 95.1%], medical doctors- assisted delivery [OR: 3.675 (95% CI (2.034–6.640)), P < 0.001, I2: 72.6%], prolonged second stage of labor [OR: 5.539 (95% CI (4.252–7.199)), P < 0.001, I2: 0.0%], using oxytocin [OR: 4.207 (95% CI (3.100–5.709)), P < 0.001, I2: 0.0%], instrument -assisted vaginal delivery [OR: 5.578 (95% CI (4.285–7.260)), P < 0.001, I2: 65.1%], and macrosomia [OR: 5.32 (95% CI (2.738–10.339)), P < 0.001, I2: 95.1%] were factors associated with episiotomy practice.ConclusionIn this review, the prevalence of episiotomy among African parturients was high. A selective episiotomy practice should be implemented to reduce the high episiotomy rates.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021293382, identifier: CRD42021293382.

背景：会阴切开术，一种在分娩过程中扩大阴道开口的手术，曾是直至21世纪初的常规实践。世界卫生组织（WHO）等机构均倡导对会阴切开术的选用进行审慎考量。然而，在发展中国家，会阴切开术的发生率依然居高不下，而在发达国家则有所下降。鉴于此，本研究旨在确定非洲地区会阴切开术的整体发生率和与之相关的风险因素。方法：通过国际电子数据库检索相关文献。采用标准化微软Excel电子表格和STATA软件版本14进行数据提取与分析。本报告遵循《系统评价与荟萃分析优先报告项目》（PRISMA）清单撰写。采用随机效应荟萃分析模型确定会阴切开术的汇总发生率。利用I-Squared（I2）统计量进行异质性检验。采用Egger检验和漏斗图检测发表偏倚。同时进行亚组分析。关联性以汇总优势比（OR）及95%置信区间（CI）表示。结果：系统评价与荟萃分析纳入了21项研究，共计40,831名参与者。会阴切开术的汇总发生率为41.7%[95% CI (36.0–47.4)，I2 = 99.3%，P < 0.001]。初产妇（OR：6.796，95% CI (4.862–9.498)，P < 0.001，I2：95.1%）、由执业医师协助分娩（OR：3.675，95% CI (2.034–6.640)，P < 0.001，I2：72.6%）、产程第二阶段延长（OR：5.539，95% CI (4.252–7.199)，P < 0.001，I2：0.0%）、使用缩宫素（OR：4.207，95% CI (3.100–5.709)，P < 0.001，I2：0.0%）、器械辅助阴道分娩（OR：5.578，95% CI (4.285–7.260)，P < 0.001，I2：65.1%）、巨大儿（OR：5.32，95% CI (2.738–10.339)，P < 0.001，I2：95.1%）等因素均与会阴切开术的实施相关。结论：在本研究中，非洲分娩妇女中会阴切开术的发生率较高。应实施选择性会阴切开术，以降低会阴切开术的高发生率。系统评价注册：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021293382，标识符：CRD42021293382。