Prevalence and risk factors for third- and fourth-degree perineal lacerations during vaginal delivery: a multi-country study

BJOG. 2012 Feb;119(3):340-7. doi: 10.1111/j.1471-0528.2011.03210.x.

Abstract

Objective: To investigate the prevalence and risk factors of third- and fourth-degree perineal lacerations in 24, mainly developing, countries.

Design: Analysis using cross-sectional data from the WHO Global Survey on Maternal and Perinatal Health.

Setting: Seven African, nine Asian and eight Latin American countries.

Population: Women at admission to hospital for delivery in 373 facilities between 2004 and 2008.

Methods: We estimated the country-wise prevalence of third- and fourth-degree perineal lacerations, and conducted region-wise multivariate logistic regression analyses to identify its risk factors.

Main outcome measures: Prevalence and risk factors of third- and fourth-degree perineal lacerations.

Results: A total of 214,599 women who underwent vaginal delivery were analysed. The prevalence of third- and fourth-degree perineal lacerations ranged widely across countries [from 0.1% (China, Cambodia, India) to 15.0% (Philippines)] and facilities (from null to 76.3%). After the deletion of facilities reporting no third- or fourth-degree perineal lacerations, and also highly outlying facilities, the range in prevalence was 0.1% (Uganda) to 1.4% (Japan). Forceps-assisted delivery, nulliparity and high birthweight were significant risk factors in all three regions. Vacuum-assisted delivery was also a significant risk factor in Africa and Asia.

Conclusions: Misdiagnosis of third- and fourth-degree perineal lacerations in developing countries may be common. Correct recognition and diagnosis may lead to timely treatment and fewer sequelae. Risk factors of third- and fourth-degree perineal lacerations in developing countries were similar to those previously reported from developed countries.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Africa / epidemiology
  • Asia / epidemiology
  • Birth Weight
  • Cross-Sectional Studies
  • Developing Countries
  • Extraction, Obstetrical / adverse effects
  • Female
  • Humans
  • Lacerations / diagnosis
  • Lacerations / epidemiology*
  • Lacerations / etiology
  • Latin America / epidemiology
  • Logistic Models
  • Multivariate Analysis
  • Obstetric Labor Complications / diagnosis
  • Obstetric Labor Complications / epidemiology*
  • Obstetric Labor Complications / etiology
  • Parity
  • Parturition
  • Perineum / injuries*
  • Pregnancy
  • Prevalence
  • Risk Factors