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The practice of episiotomy in public hospitals in Hong Kong
KW Lam, HS Wong, TC Pun
Department of Obstetrics and Gynaecology, University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong
OBJECTIVE. To review the use of episiotomy during
vaginal delivery in Hong Kong public hospitals.
DESIGN. Prospective observational survey.
SETTING. Public hospitals, Hong Kong.
PARTICIPANTS. Women who underwent normal vaginal
delivery of a singleton foetus with cephalic presentation.
MAIN OUTCOME MEASURES. Number of women having an
episiotomy, severe-degree (third- or fourth-degree) tear, other
types of tear, blood loss at delivery, postpartum haemorrhage, need
for blood transfusion, puerperal pyrexia, wound infection, gaping
wound that required suture removal, and drainage or resuturing of
a perineal wound.
RESULTS. Between 1 January and 31 March 2003, there
were 6222 singleton spontaneous normal vaginal deliveries in the
public hospitals of Hong Kong. Of the 6167 women in whom the status
of the perineum was known, episiotomy was performed in 5274 (85.5%).
Primiparous women were more likely to undergo episiotomy at delivery
than multiparous women (97.9% vs 71.4%). Women with episiotomy had
significantly less perineal tearing of any kind than those without.
The occurrence of any type of perineal tear and severe-degree (third-
or fourth-degree) tear was significantly lower in primiparous women
who had an episiotomy than those without (P<0.05). Women with
episiotomy had increased mean blood loss at delivery but other complications
were not significantly increased.
CONCLUSIONS. In Hong Kong, episiotomy is routinely
performed during normal vaginal delivery. It is associated with
a significantly lower overall rate of perineal tearing. This study
was observational, nonetheless the occurrence of other complications
was likely to increase when episiotomy was performed. Firm evidence
from several randomised controlled studies shows that routine episiotomy
is unjustified and possibly harmful. Routine episiotomy should not
be promoted in Hong Kong without further randomised controlled study.
Hong Kong Med J 2006;12:94-8
Key words: Delivery, obstetric; Episiotomy; Parity; Perineum/injuries; Pregnancy
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