Outcome of Episiotomy Repair by House Officers at the Niger Delta University Teaching Hospital, Nigeria

Abstract

Background: Episiotomy is the commonest operative procedures in obstetrics, and belied by many to expedite delivery. In most tertiary hospitals in Nigeria, majority of the episiotomies are repaired by house officer, with varying degree of complications. Objective: To determine the complications of episiotomy repair by house officers, using repair by resident doctors as control. Specifically, it would evaluate the rate of wound dehiscence, perineal pain, estimated blood loss, acute urinary retention, vulva hematoma and dyspareunia. Materials and Methods: A comparative study of 400 parturients who were admitted in labour, delivered vaginally, and had episiotomy repair at the Niger Delta University Teaching Hospital in Bayelsa State, Southern Nigeria. Episiotomy repair was carried out in the labour ward by house officers (200 subjects), and resident doctors (200 subjects). All the episiotomies were mediolateral and repaired with polyglactic acid suture, size 0. Using those repaired by resident doctors as control, assessment of the patients was carried within 24 hours for: perineal pain, acute urinary retention, delivery to repair interval, estimated blood loss and vulva hematoma. The next assessment was at 7 days postpartum for perineal pain and wound healing. Finally, they were evaluated at 6 weeks for complete wound healing, perineal pain, and dyspareunia. Results: There was no significant difference in the rate of wound dehiscence between the 2 groups. However, episiotomy repair by house officers was associated with more vulva hematomas, Odds Ratio = 6.15[CI, 0.73 – 51.60], immediate postoperative pain, P = 0.04[CI, 0.71 – 1.06], and superficial dyspareunia. Conclusion: Women whose episiotomies were repaired by house officers experience more postoperative morbidity than those repaired by resident doctors. If house officers will continue to repair most of the episiotomies, a more intensive training is recommended.