Perineal Tears; Frequency, Severity and Risk factors in a Tertiary Care Hospital

Objective: To observe the frequency, severity, and risk factors of perineal tears during vaginal delivery in a tertiary care hospital.  Methodology: This was a cohort study of women, aged 15-45 years, of ≥ 36 weeks gestation, with a cephalic presentation, delivered between 1st January and 30th December 2021 at Lady Reading Hospital, Peshawar. A structured proforma was used to gather data on women’s demographic, obstetric, and labour details. Women with perineal tears were grouped into the minor tears group (first and second-degree) and the major tears group (third and fourth-degree). Institutional Ethics Review Committee approval was taken (266/LRH/MTI). Results: Among the 7304 deliveries, 876 women sustained perineal tears constituting a frequency of 11.99%. About 740 (84.5%) women had minor tears (First degree, n=256, Second degree, n=484), and136 (15.5%) had major tears (Third degree, n=99, Fourth degree, n=37). The mean age, body mass index and gestational age was 30.19+6.10 (range; 15-45), 32.02+2.77 (range; 25-40), and 38.9+1.53 (range; 36-42) respectively. Women with an instrumental vaginal delivery were more prone to have a major tear in comparison to a spontaneous vaginal delivery (p< 0.00). Primiparity, oxytocin, shoulder dystocia, instrumental vaginal delivery, and high birth weight were significantly associated with perineal tears. Women with instrumental vaginal delivery were more likely to have major tears without an episiotomy. Conclusions: Perineal tear is frequent post-natal morbidity. Perineal tears are significantly high in primiparous women, oxytocin, shoulder dystocia, instrumental vaginal delivery, and high birth weight. Episiotomy should be given only when indicated. Keywords: Perineal tears, Episiotomy, Risk factors.