Abstract
Trauma to the perineum following vaginal delivery is common and can lead to anal incontinence and pain but can be prevented by perineal support. However, the incidence and how to prevent perineal injury in sub Saharan Africa has not previously been described. The objective of the study was to assess the incidence of perineal trauma at vaginal delivery and to assess a training intervention in perineal support using a criterion-based audit (CBA) design. A CBA was conducted at Kilimanjaro Christian Medical Centre in Tanzania. In total, 552 women who delivered vaginally were included, of whom 80% completed a follow-up interview after three months. Perineal support as trained for this study was not performed before the intervention but was performed in 78.6% of deliveries after the intervention (p<0.000). The number of women with second degree lacerations decreased after the intervention (RR 0.74, CI: 0.61-0.90), and more had an intact perineum (RR 2.85, CI: 1.74-4.69). Anal sphincter lacerations were not significantly changed by the intervention (6.6 to 3.4%, RR 0.52, CI: 0.24-1.14). The frequency of anal incontinence changed insignificantly from 6.1 to 4.9% (RR 0.81, CI: 0.37-1.77) after intervention. Perineal pain three months after delivery was reduced by 72% (RR 0.28, CI: 0.15-0.52). The study demonstrates that CBA may be useful in introducing a simple intervention such as perineal support thereby decreasing the number of women having perineal trauma following vaginal delivery. However, the impact of our intervention on the sustainability of our observations is uncertain and must await long-term studies. Key words: Clinical audit, developing countries, perineum, trauma, obstetric labor, complications.  
Highlights
An estimated 70 to 85% of women sustain some degree of trauma to the perineum during childbirth (Rikard-Bell et al, 2014; Webb et al, 2014)
Diagnosis and management are essential to reduce the risk of short-term complications like bleeding, infection and pain
The primary objective of this study was to assess the incidence of perineal trauma using criterion-based audit (CBA) in a hospital in a low-income country
Summary
An estimated 70 to 85% of women sustain some degree of trauma to the perineum during childbirth (Rikard-Bell et al, 2014; Webb et al, 2014). Diagnosis and management are essential to reduce the risk of short-term complications like bleeding, infection and pain. Vaginal childbirth and perineal trauma of third and fourth degree, called obstetric anal sphincter injuries (OASIS), are important risk factors for AI (Bols et al, 2010; LaCross et al, 2015). A simple option in order to reduce AI is pelvic floor muscle training (PFMT), which has been demonstrated to be effective for prevention and treatment (Boyle et al, 2014)
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