Perineal length among Vietnamese women.

OBJECTIVE: Vietnamese clinicians routinely perform episiotomies in the belief that 3rd-4th degree tears may be prevented, based partly on the view that Vietnamese women have a short perineal length that puts them at increased risk of tears. However, there is no evidence to suggest Vietnamese women have a short perineum compared with other populations. We aimed to determine the mean perineal length among Vietnamese women in early labor and in the second stage, and to compare this to findings from similar studies in other populations. MATERIALS AND METHODS: We undertook an observational study in a tertiary obstetric hospital in Vietnam from October 2014 to June 2015. Pregnant women who presented in early labor with a live singleton cephalic presentation at ≥37 weeks gestation were eligible. Perineal length was measured early in the 1st stage of labor (≤4 cm dilation) and in 2nd stage of labor (10 cm dilation). Mean perineal length was compared to other populations using t-tests. RESULTS: Of 395 women, 159 (40.3%) were nulliparous and 236 (59.8%) multiparous. Overall the mean perineal length in early labor was 3.4 cm (±0.4), and did not differ by parity. Mean perineal length among Vietnamese women was significantly shorter (P < 0.001) than other populations (means 3.8-4.6 cm). Among 365 women who reached 2nd stage the mean perineal length was 4.3 cm (±0.6). CONCLUSION: The perception that Vietnamese women have a relatively shorter perineal length appears to have some basis and outcomes reported from episiotomy trials may not be generalizable to Vietnamese women.

Knowledge, attitude and experience of episiotomy use among obstetricians and midwives in Viet Nam.

BACKGROUND: Episiotomy remains a routine procedure at childbirth in many South-East Asian countries but the reasons for this are unknown. The aim of this study was to determine the knowledge of, attitudes towards and experience of episiotomy use among clinicians in Viet Nam. METHODS: All obstetricians and midwives who provide delivery care at Hung Vuong Hospital were surveyed about their practice, knowledge and attitudes towards episiotomy use. Data were analysed using frequency tabulations and contingency table analysis. RESULTS: 148 (88%) clinicians completed the questionnaire. Fewer obstetricians (52.2%) than midwives (79.7%) thought the current episiotomy rate of 86% was about right (P < 0.01). Most obstetricians (82.6%) and midwives (98.7%) reported performing episiotomies on nulliparous women over 90% of the time. Among multipara, 24.6% of obstetricians reported performing episiotomy less than 60% of the time compared with only 3 (3.8%) midwives (P < 0.01). Aiming to reduce 3rd-4th degree perineal tears was the most commonly reported reason for performing an episiotomy by both obstetricians (76.8%) and midwives (82.3%), and lack of training in how to minimize tears and keep the perineum intact was the mostly commonly reported obstacle (obstetricians 56.5%, midwives 36.7% P = 0.02) to reducing the episiotomy rate. CONCLUSION: Although several factors that may impede or facilitate episiotomy practice change were identified by our survey, training and confidence in normal vaginal birth without episiotomy is a priority.

Episiotomy rate in Vietnamese-born women in Australia: support for a change in obstetric practice in Viet Nam.

OBJECTIVE: To describe the use of episiotomy among Vietnamese-born women in Australia, including risk factors for, and pregnancy outcomes associated with, episiotomy. METHODS: This population-based, retrospective cohort study included data on 598 305 singleton, term (i.e. ≥ 37 weeks' gestation) and vertex-presenting vaginal births between 2001 and 2010. Data were obtained from linked, validated, population-level birth and hospitalization data sets. Contingency tables and multivariate analysis were used to compare risk factors and pregnancy outcomes in women who did or did not have an episiotomy. FINDINGS: The episiotomy rate in 12 208 Vietnamese-born women was 29.9%, compared with 15.1% in Australian-born women. Among Vietnamese-born women, those who had an episiotomy were significantly more likely than those who did not to be primiparous, give birth in a private hospital, have induced labour or undergo instrumental delivery. In these women, having an episiotomy was associated with postpartum haemorrhage (adjusted odds ratio, aOR: 1.26; 95% confidence interval, CI: 1.08-1.46) and postnatal hospitalization for more than 4 days (aOR: 1.14; 95% CI: 1.00-1.29). Among multiparous women only, episiotomy was positively associated with a third- or fourth-degree perineal tear (aOR: 2.00; 95% CI: 1.31-3.06); in contrast, among primiparous women the association was negative (aOR: 0.47; 95% CI: 0.37-0.60). CONCLUSION: Episiotomy was performed in far fewer Vietnamese-born women giving birth in Australia than in Viet Nam, where more than 85% undergo the procedure, and was not associated with adverse outcomes. A lower episiotomy rate should be achievable in Viet Nam.