Severe Perineal Trauma in a Brazilian Southeastern Tertiary Hospital: A Retrospective Cohort Study

Risk factors associated with severe perineal tear at Public Hospitals in Bahir Dar town, Northwest Ethiopia

Background

Birth-related perineal trauma is a public health issue that can lead to significant maternal morbidity in low-income countries like Ethiopia. Research on the proportion and underlying factors of birth-related severe perineal tears is rare, both in the study area and throughout Ethiopia. As a result, this study was intended to determine the proportion of birth-related severe perineal tears and associated factors at hospitals in Bahir Dar town, Ethiopia.

Methods

A cross-sectional study was undertaken at government hospitals in Bahir Dar, Ethiopia. Five hundred fifteen study subjects were selected using a systematic sampling technique. The data was collected through chart reviews and interviews. Data was entered and analyzed using SPSS Version 23. A binary logistic regression was employed to identify factors, and an adjusted odds ratio and a 95% CI were used to estimate the strength of relationships. Statistical significance was declared at p-value < 0.05.

Result

The prevalence of severe perineal tears was 7.4%. Previous history of a perineal tear (AOR = 3.06, 95% CI = 1.24-7.59), being nullipara (AOR = 4.03, 95% CI = 1.42-11.44), occipito-posterior position (AOR = 5.49, 95% CI = 2.27-13.28), duration of second stage of labor > 2 h (AOR = 5.42, 95% CI = 2.26-12.99), birth attendant's work experience <1 year (AOR = 5.98, 95% CI = 2.16-16.57) were found to be associated with birth-related severe perineal tear.

Conclusion

The proportion of birth-related severe perineal tears was high at governmental hospitals in Bahir Dar town. Previous history of perineal tear, work experience of birth attendants, duration of the second stage of labor, being nullipara, and occipito-posterior position were the major determinants of severe perineal tear. This study suggests that strategies and regulations should be developed to shorten the second stage of labor.

Neonatal head circumference as a risk factor for obstetric anal sphincter injuries: a systematic review and meta-analysis

OBJECTIVE

Between 53% and 79% of women will sustain some degree of perineal laceration during vaginal delivery. Third- and fourth-degree perineal lacerations are known as obstetric anal sphincter injuries. Timely diagnosis and prompt treatment of obstetric anal sphincter injuries can help to prevent the development of severe consequences like fecal incontinence, urinary incontinence, and rectovaginal fistula. Neonatal head circumference is routinely measured postpartum but is often not mentioned as a risk factor for obstetric anal sphincter injuries in clinical guidelines. Thus far, no review article on the risk factors for obstetric anal sphincter injuries has discussed the role of neonatal head circumference. This study aimed to review and analyze the relationship between head circumference and the occurrence of obstetric anal sphincter injuries among previous studies to conclude whether head circumference should be recognized as an important risk factor.

DATA SOURCES

Through study screening on Google Scholar, PubMed, Scopus, and Science Direct for articles published between 2013 to 2023, followed by assessment of eligibility, this study ended up reviewing 25 studies, 17 of which were included in the meta-analysis.

STUDY ELIGIBILITY CRITERIA

Only studies that reported both the neonatal head circumference and the occurrence of obstetric anal sphincter injuries were included in this review.

METHODS

The included studies were appraised using the Dartmouth Library risk of bias assessment checklist. Qualitative synthesis was based on the study population, findings, adjusted confounding factors, and suggested causative links in each study. Quantitative synthesis was conducted using calculation and pooling of odds ratios and inverse variance using Review Manager 5.4.1.

RESULTS

A statistically significant association between head circumference and obstetric anal sphincter injuries was reported in 21 of 25 studies; 4 studies reported that head circumference was a true independent risk factor. A meta-analysis of the studies that reported neonatal head circumference as a dichotomous categorical variable with a cutoff point of 35±1 cm yielded statistically significant pooled results (odds ratio, 1.92; 95% confidence interval, 1.80-2.04).

CONCLUSION

The risk for obstetric anal sphincter injuries increased as the neonatal head circumference increased-this should be considered in decision-making during labor and postpartum management to attain the best outcome.

Spontaneous Perineal Trauma during Non-Operative Childbirth—Retrospective Analysis of Perineal Laceration Risk Factors

Childbirth-related perineal trauma (CRPT) is defined as damage to the skin, muscles of the perineum, as well as to the anal sphincter complex and anal epithelium. The aim of the study was to analyze the risk factors for spontaneous injuries to the soft tissues of the birth canal during non-operative delivery. This was a single-center retrospective case-control study. The study included the analysis of two groups, the study group featured 7238 patients with spontaneous perineal laceration (any degree of perineal laceration) and the control group featured patients without perineal laceration with 7879 cases. The analysis of single-factor logistic regression showed that the factors related to perineal laceration during childbirth are the age of the patients giving birth (p = 0.000), the BMI before delivery (p = 0.000), the number of pregnancies (p = 0.000) and deliveries (p = 0.000), diagnosed gestational diabetes (p = 0.046), home birth (p = 0.000), vaginal birth after cesarean (VBAC) (p = 0.001), the use of oxytocin in the second stage of childbirth (p = 0.041), the duration of the second stage of childbirth (p = 0.000), body weight (p = 0.000), and the circumference of the newborn head (p = 0.000). Independent factors that increase the risk of perineal laceration during childbirth are an older age of the woman giving birth, a history of cesarean section, a higher birth weight of the newborn, and factors that reduce the risk of spontaneous perineal trauma are a higher number of deliveries and home birth.

Birth-Related Perineal Tear and Its Associated Factors Among Mothers Who Delivered in Atat Hospital

INTRODUCTION

Birth-related perineal tear or laceration(s) are related to vaginal delivery. Perineal laceration(s) can results in serious maternal morbidity and even mortality in low and middle-income countries, including Ethiopia. The prevalence and determinants of birth-related perineal tear have not been well studied in Ethiopia, particularly in the study area of this research. Therefore, the aims of this research were to determine the prevalence and determinants of birth-related perineal tear among mothers who delivered in Atat Hospital in southern Ethiopia. It was another aim of this study to design an evidence-based intervention and prevention strategies for the reduction of a BPT in the study area and the country based on analysis of data acquired in this research.

METHODS

A hospital-based cross-sectional study was conducted at Atat Hospital from March 1 to August 30, 2021. A total of 422 mothers were included. A systematic random sampling procedure was used to select the study participants. Chart review and interviewer-administered questionnaires were used to collect data. Data entry and analysis were done by using Epi info 7 and SPSS version 20. The strength of associations was assessed by using an adjusted odds ratio with a 95% confidence interval (CI) and statical significance was considered at p-value of less than (<) .05.

RESULT

The prevalence of perineal tears in Atat Hospital was 152 (38.4%) among 396 delivered mothers (95% CI 33.8, 43.4%). Variables found to be related to perineal tear(s) included an episiotomy, (AOR, 2.145,95% CI 1.051, 4.378), fundal pressure (AOR, 7.409, 95% CI 3.157, 17.384), augmentation, (AOR, 4.608,95% CI 2.139, 9.927), and neonatal head circumference (AOR, 3.427,95% CI 2.377, 4.923). These four variables were significantly associated with the perineal tear (p < .05).

CONCLUSION

The prevalence of perineal trauma in this study was high may be be minimized with the use of indicated episiotomy and the lack of fundal pressure. Fundal pressure, augmentation, an episiotomy, and neonatal head circumference were significantly associated factors with the occurrence of perineal tears.