A multicenter cross-sectional study of episiotomy practice in Romania.

RATIONALE, AIMS, AND OBJECTIVES: The aim of this study was to focus attention on episiotomy practice in Romanian maternity units in order to identify factors associated with the very high rate of the procedure in Romania and to consider strategies to reduce it. METHODS: In this clustered cross-sectional study, a total of 11 863 patients were recorded in eight Romanian maternity units to assess the prevalence of episiotomy. A random effects Poisson model was used to estimate the prevalence rate in univariate and multivariate models. RESULTS: Among the 11 863 patients included for analysis, 8475 (71.4%) had an episiotomy. The prevalence of episiotomy was 92.7% for the first vaginal birth, 73.2% for the second vaginal birth, and 35% for the third vaginal birth. The overall rate of suturing was higher than the episiotomy rate for all patients (total rate 79.2%). The likelihood of exiting the maternity ward with an intact perineum after the first vaginal birth was less than 5% at the first vaginal birth. CONCLUSIONS: In conclusion, routine episiotomy is the norm in Romanian maternity units, with episiotomy rates among the highest in Europe. Episiotomy use is mainly driven by local professional norms, experiences, previous training, and practitioners' decisions rather than evidence, guidelines, or variations in patient needs at the time of vaginal birth.

Teenage Pregnancies: Risk Factors and Associated Neonatal Outcomes in an Eastern-European Academic Perinatal Care Center.

OBJECTIVES: This study aims to compare women with early (13-16 years), late teenage (17-19 years), and adult (25-29 years) pregnancies regarding pregnancy risk factors and reproductive outcomes. METHODS: An observational study, utilizing medical charts and direct interview, conducted in an academic hospital during January 2011 and December 2012. Our sample comprised 395 teenage and 736 adult pregnancies. RESULTS: Pregnant teenagers were more likely than adults to be single (41.7 vs. 33.2%; odds ratio [OR]: 1.43, 95% confidence interval [CI]: 1.11-1.84), to live in a rural area (70.9 vs. 53.9%; OR: 2.07, 95% CI: 1.60-2.69), and to live with extended family (74.2 vs. 16.0%; OR: 15.04, 95% CI: 11.15-20.29). Adolescent mothers were more likely than adult mothers to give birth by vaginal delivery (78.5 vs. 69.6%; OR: 1.82, 95% CI: 1.17-2.84), and rate of operative delivery was lower amongst this group (8.6 vs. 9.8%; OR: 0.8, 95% CI: 0.5-1.3). The newborns of adolescent mothers were more likely to be low birth weight (14.9 vs. 9.1%; OR: 1.75, 95% CI: 1.20-2.54) and more likely to successfully breastfeed (91.9 vs. 82.2%; OR: 2.45; 95% CI: 1.63-3.69) but the length of hospital stay was similar with adult mothers' newborns. CONCLUSIONS: The distinct risk factors and behaviors associated with pregnancy, among teenagers may help address the health needs of this unique and vulnerable group and their offspring.