Contributing factors for episiotomy in primiparous women in a tertiary hospital in Perak, Malaysia.

INTRODUCTION: Episiotomy is a surgical incision of the perineum performed during vaginal delivery. Although previously routine, current evidence supports a selective approach due to associated maternal morbidity. Despite this, episiotomy remains common among primiparous women. This study aimed to determine the prevalence and contributing factors for episiotomy among primiparous women in a tertiary hospital in Perak, Malaysia. MATERIALS AND METHODS: A cross-sectional study was conducted using secondary data from the obstetric delivery registry of Hospital Raja Permaisuri Bainun, Ipoh. Records of primiparous women who underwent vaginal delivery with episiotomy between 1 January and 31 December 2024 were reviewed. Maternal demographics and clinical indications were analysed. Associations between demographic variables and type of episiotomy were assessed using chisquare tests. RESULTS: Of 346 eligible cases, 311 were analysed. Routine episiotomy accounted for 76.5% of cases, while 23.5% were selective. The most common indications for selective episiotomy were cord around the neck (45.2%) and preterm delivery (39.7%). No significant association was found between type of episiotomy and maternal age (p=0.378) or ethnicity (p=0.981). CONCLUSION: Routine episiotomy remains the predominant practice among primiparous women in this tertiary Malaysian hospital. These findings highlight the need for institutional review and adherence to evidence-based selective episiotomy guidelines.