National Perinatal Information Center
National Perinatal Information Center


NATIONAL QUALITY FORUM PERINATAL CARE PROJECT

Measure Steward: Incidence of Episiotomy


Background:

Matthew K. Hoffman, MD, Department of Obstetrics and Gynecology, and Linda Daniel, RN, MSN, Director Performance Improvement and Care Management for the Women's & Children Service Line at Christiana Care Health Services, Newark, DE in conjunction with the National Perinatal Information Center/Quality Analytic Services (NPIC/QAS) submitted one of the endorsed measures: Incidence of Episiotomy.

Measure Definition:

Numerator Statement: Number of episiotomy procedures (ICD-9 code 72.1, 72.21, 72.31, 72.71, 73.6; ICD-10 code 0W8NXZZ) performed.

Denominator Statement: Total number of vaginal deliveries.

Exclusions: Deliveries coded with shoulder dystocia. (ICD-9 code 660.41; ICD-10 code O66.0)

References/Scientific Acceptability    

1. Martin JA, Hamilton BE, Ventura SJ, Menacker F, Park MM. Births: final data for 2000. Natl Vital Stat Rep 2002;50(5):1-101. (Level II-3)

2. Myles TD, Santolaya J. Maternal and neonatal outcomes in patients with prolonged second stage of labor. Obstet Gynecol 2003;102:52-8. (Level II-3)

3. Bodner-Adler B, Bodner K, Kimberger O, Wagenbichler P, Mayerhofer K. Management of the perineum during forceps delivery. Association of episiotomy with the frequency and severity of perineal trauma in women undergoing forceps delivery. J Reprod Med 2003;48:239-42. (Level II-3)

4. Thacker SB, Banta HD. Benefits and risks of episiotomy: an interpretive review of the English language literature, 1860-1980. Obstet Gynecol Surv 1983;38:322-38. (Level III)

5. Bodner-Adler B, Bodner K, Kaider A, Wagenbichler P, Leodolter S, Husslein P, et al. Risk factors for third-degree perineal tears in vaginal delivery, with an analysis of episiotomy types. J Reprod Med 2001;46:752-6. (Level II-3)

6. Riskin-Mashiah S, O'Brian Smith E, Wilkins IA. Risk factors for severe perineal tear: can we do better? Am J Perinatol 2002;19:225-34. (Level II-2)

7. Helwig JT, Thorp JM Jr, Bowes WA Jr. Does midline episiotomy increase the risk of third- and fourth-degree lacerations in operative vaginal deliveries? Obstet Gynecol 1993;82:276-9. (Level II-2)

8. Shiono P, Klebanoff MA, Carey JC. Midline episiotomies: more harm than good? Obstet Gynecol 1990;75:765-70. (Level II-2)

9. Fenner DE, Genberg B, Brahma P, Marek L, DeLancey JO. Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol 2003;189:1543-50. (Level II-3)

10. Barranger E, Haddad B, Paniel BJ. Fistula in ano as a rare complication of mediolateral episiotomy: report of three cases. Am J Obstet Gynecol 2000;182:733-4. (Level III)

11. Bodner-Adler B, Bodner K, Kimberger O, Wagenbichler P, Mayerhofer K. Management of the perineum during forceps delivery. Association of episiotomy with the frequency and severity of perineal trauma in women undergoing forceps delivery. J Reprod Med 2003;48:239-42. (Level II-3)

12. Macarthur AJ, Macarthur C. Incidence, severity, and determinants of perineal pain after vaginal delivery: a prospective cohort study. Am J Obstet Gynecol 2004;191:1199-204. (Level II-2)

13. Signorello LB, Harlow BL, Chekos AK, Repke JT. Postpartum sexual functioning and its relationship to perineal trauma: a retrospective cohort study of primiparous women. Am J Obstet Gynecol 2001;184:881-7; discussion 888-90. (Level II-2)

14. ACOG Practice Bulletin No. 71. Episiotomy. American College of Obstetricians and Gynecologists. Obstet Gynecol April 2006;107:957-62.

15. Howden NL. Weber AM. Meyn LA. Episiotomy use among residents and faculty compared with private practitioners. Obstetrics & Gynecology. 103(1):114-8, 2004 Jan

16. Goode KT. Weiss PM. Koller C. Kimmel S. Hess LW, Episiotomy rates in private vs. resident service deliveries: a comparison. Journal of Reproductive Medicine. 51(3):190-2, 2006 Mar

17. Goldberg J, Purfield, P, Roberts, N, Lupinacci, P, Fagan, M, Hyslop, The Philadelphia episiotomy intervention study. The Journal of Reproductive Medicine. 51(8). 603-609. 2006 Aug

18. Roberts, LL, Ely, JW, WArd, MM, Factors contributing to maternal birth-related trauma. American Journal of Medical Quality. 22(5) 334-343. 2007 Sep/Oct

19. NIH statement on adult incontinence (Free) http://consensus.nih.gov/2007/incontinencestatement.htm

20. Klein MC. Sakala C. Simkin P. Davis-Floyd R. Rooks JP. Pincus J.Why do women go along with this stuff? Birth. 33(3):245-50, 2006 Sep.

If you have any questions regarding this measure, please e-mail Janet Muri, President NPIC/QAS, Matthew Hoffman, MD, or Linda Daniel, RN.

Endorsement Renewed: November 29, 2016
Endorsement Renewed: April 2, 2012
Initial Endorsement: October 24, 2008
 
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