Pattern of perineal tears during vaginal delivery at a public sector University Hospital of Sindh

Objective: To determine the pattern of perineal tears during vaginal delivery in a tertiary healthcare facility. Methodology: It is a descriptive study done in the Department of Obstetrics and Gynaecology Unit-I at Liaquat University Hospital Hyderabad, Pakistan from 1 September 2004 to 31 August 2005. Women with full term singleton pregnancy either primi or multigravida, in active labour were selected for the study. An informed consent was taken from all the participants. Twin pregnancy and ante-partum haemorrhage were excluded Age, parity, type and degree of tear, mode of delivery, birth weight of baby, birth attendant, risk factors and complications were noted. Results: There were 2563 deliveries, 256 patients had some degree of perineal injury giving a frequency of 9.9%. Out of them, 100 patients were selected, 37(37.0%) of multiparous and 63(63.0%) of primiparous sustained some degree of perineal injury. A higher incidence of first and second degree tears were noted and incidence was found to be more when vaginal delivery was conducted without episiotomy and fetal weight was more than 4kg. However duration of labour, perineal support, presence of perineal edema and experience of the birth attendant were important risk factors. Conclusion: Obstetric perineal tears are common as depicted by the high frequency in this study. Lack of perineal care, poor socio-economic conditions, poor intra-partum care with lack of experience were found to be contributing factors in the occurrence of perineal tears.