The Effect of Antenatal and Intrapartum Factors on Episiotomy Wound Dehiscence

Episiotomy is the most common labour ward procedure in obstetrics. Improper healing of the episiotomy wound can lead to prolonged and sometimes serious post-partum morbidity. Also, if infected, they may manifest as a surgical site infection and may lead to generalised sepsis. In this study, we aim to critically evaluate cases of episiotomy wound gapes and study antenatal, intrapartum, and infective causes for the same. This study aimed to study the prevalence and causes of episiotomy wound dehiscence and the maternal co-morbidities associated with them in a tertiary care centre. Methods: This observational, hospital-based prospective cross-sectional study conducted at the Department of Obstetrics and Gynaecology, Seth GS Medical College and KEM Hospital from 2017-2018. A total of 30 cases of episiotomy wound dehiscence were studied. The rate of episiotomy wound dehiscence was 2.14% for the year 2017-2018. More than half (60%) of the patients have a wound dehiscence were overweight or obese. Anaemia, obesity, diabetes mellitus, and hypothyroidism were the main antenatal high-risk factors identified. In the intrapartum factors, wound dehiscence was more common in patients in whom labour was induced and those undergoing instrumental delivery. 70% of the cases were diagnosed between post-partum day 7-14, and the main presenting complaint was pain at the episiotomy site. The main organisms noted in infected wounds were Escherichia Coli and Klebsiella Pneumoniae. In conclusion, episiotomy wound dehiscence is an important cause of post-partum morbidity and prolonged hospital stay. This study revisits the need to correct antenatal factors like obesity, anaemia, and hypothyroidism and highlights the need to refine intrapartum practices and post-natal follow up in patients at high risk for this condition.