Abstract

Background: Episiotomy at the time of vaginal birth is a common lifesaving surgical procedure.  In Ethiopia, several studies have been conducted concerning on the proportion of episiotomy. However, its prevalence/ proportion varies across these series of studies. Thus, this systematic review and meta-analysis estimates the pooled prevalence of episiotomy practice among laboring women in Ethiopia.

Methods: The systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. We systematically searched the databases: PubMed /MEDLINE, EMBASE, Google Scholar, and Science Direct for studies conducted in Ethiopia about episiotomy. We included all cross-sectional studies, which were published until July 5th,2020. Data were analyzed using R Version 3.6.1 software. The pooled estimates with 95% confidence intervals (CI) were presented using forest plots. A random effects meta-analysis was conducted on extracted crude rates to arrive at national and regional pooled estimates for the country. I squared test and Egger’s regression test were used to assess heterogeneity and publication bias respectively.

Results: Our search yielded 392 articles. Ten studies covering five administrative regions and 6404 vaginally delivered women were involved. The mean age of the study participants was ranged from 22-27.7 years. The estimated overall pooled prevalence of episiotomy in Ethiopian women was 37.82% (95%CI:31, 56, 44.09%). In the subgroup analysis, the pooled prevalence of episiotomy was 52% (95%CI:44, 61%) among primiparous women, meanwhile among multiparous women the pooled estimate appears to be around 26.51% (95% CI: 18.54, 34.47%).

Conclusion: Our finding noted that the pooled prevalence of episiotomy was obviously higher than the evidence-based WHO recommendations for optimal patient care.  Nulliparous women had a higher rate of episiotomy than multiparous women in this study.  This fact calls for continuous retraining of labor ward staff especially the health care providers who usually conduct most of the deliveries.

Keywords: Episiotomy; Practice; Systematic review; Meta-analysis