Perineal Tears Incidence and Risk Factors; A Four Years Experience in a Single Saudi Center:(IGWHC) - Lupine Publishers



Background: Perineal trauma is a common event in obstetrics, affecting up to 90 percent of primiparous and is sometime associated with considerable post-natal morbidity and mortality [1]. These patients are at an increased risk of recurrent severe perineal lacerations in subsequent deliveries [2]. Many of these patients develop subsequent anal incontinence and sexual dysfunction despite an adequate primary sphincter repair [3].
Objectives: The aim of the study is to highlight the frequency and severity of perineal tears during vaginal delivery which leads to major physical, psychological and social problems.
Study Design and Methods: This retrospective cohort study analyzed all vaginal deliveries from January 2011 to December 2015 in Security Forces Hospital, Riyadh, Saudi Arabia. The Hospital has around 6000 deliveries per year. Data were extracted from dedicated database software for antenatal care through Hospital System (Medical Record Viewer MRV) and from Midwife Head Nurse daily record system. The data used were already available for the analysis for all patients as part of the clinical report of the Obstetrics and Gynecology Department of Security Forces Hospital.
Results: A total of 28325 patients were admitted for vaginal deliveries. Of them, 406 (1.4 %) patients sustained second, third or fourth degree perineal tears. Of the 406 patients, 285 (70.1%) were primiparous and 121 (29.9%) were multiparous. The mean age of the study population was 28.08±7.47, ranging between 17-42 years (Table 1). Of the total, 139 (32%) delivered spontaneously, while 276 (68%) delivered with the help of vacuum delivery. The primigravida were significantly associated with the frequency of severe lacerations (p<0.006). Perineal tears were not significantly associated with episiotomy (p<0.623). The occurrence of tears was in 313 (44.3%) when birth weight > 4 Kg (p <0.001).
Conclusions: Perineal tears cause considerable post-natal morbidity. Identification of risk factors, vigilant monitoring and supervision by senior doctors during difficult deliveries and good perineal support is recommended for minimizing the risk of perineal trauma as well as morbidity.


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