Table_3_Episiotomy Practice and Its Associated Factors in Africa: A Systematic Review and Meta-Analysis.DOC

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（Episiotomy）是一种在分娩过程中扩大阴道开口的外科手术，直至21世纪初仍为临床常用操作。包括世界卫生组织（WHO）在内的诸多机构均倡导选择性应用会阴切开术。然而，发展中国家的会阴切开术使用率仍居高不下，发达国家的使用率则呈下降趋势。为此，本研究旨在明确非洲地区会阴切开术的总体流行率，并分析与其实施相关的危险因素。 方法 于国际电子数据库中检索相关文献。分别采用标准化Microsoft Excel表格与STATA 14.0软件完成数据提取与统计分析。本报告遵循系统评价与Meta分析首选报告条目（PRISMA）清单撰写。采用随机效应Meta分析模型计算会阴切开术的合并流行率，通过I²（I-Squared）统计量进行异质性检验，采用Egger检验与漏斗图检测发表偏倚，并开展亚组分析。关联效应以合并比值比（OR）及95%置信区间（CI）进行表述。 结果 本系统评价与Meta分析共纳入21项研究，涉及40831名研究对象。会阴切开术的合并流行率为41.7% [95%CI(36.0~47.4)，I²=99.3%，P<0.001]。与会阴切开术实施相关的危险因素包括：初产[OR=6.796，95%CI(4.862~9.498)，P<0.001，I²=95.1%]、医师辅助分娩[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%]、缩宫素应用[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%]以及巨大儿[OR=5.32，95%CI(2.738~10.339)，P<0.001，I²=95.1%]。 结论 本研究显示，非洲产妇的会阴切开术流行率较高，应推行选择性会阴切开术以降低当前过高的会阴切开术使用率。 系统评价注册 注册链接：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021293382，注册编号：CRD42021293382。