Table_6_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操作，在21世纪初之前一直是常规实践。世界卫生组织（WHO）等机构均倡导选择性应用会阴切开术。然而，在发展中国家，会阴切开术的比率仍然很高，而在发达国家则有所下降。因此，本研究旨在确定非洲地区会阴切开术的总体普及率及其相关风险因素。方法：通过国际电子数据库检索相关文章。分别使用标准化的微软Excel电子表格和STATA软件版本14进行数据提取和分析。本报告采用了《系统评价与荟萃分析报告规范》（PRISMA）清单进行撰写。运用随机效应荟萃分析模型以确定会阴切开术的合并发生率。通过I-Squared（I2）统计量进行异质性检验。采用Egger检验和漏斗图以检测发表偏倚。同时进行了亚组分析。关联性通过合并优势比（OR）及其95%置信区间（CI）进行表达。结果：系统评价和荟萃分析共纳入21项研究，包含40,831名参与者。会阴切开术的合并发生率为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%]、助产医师协助分娩[OR: 3.675 (95% CI (2.034–6.640)), P < 0.001，I2: 72.6%]、第二产程延长[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%]和巨大儿[OR: 5.32 (95% CI (2.738–10.339)), P < 0.001，I2: 95.1%]等因素与会阴切开术的实践相关。结论：在本研究中，非洲产妇中会阴切开术的比率较高。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。