Prevalence and Risk Factors for Perineal Trauma among Women at a Teaching and Referral Hospital in Kenya

Jacqueline M Kituku ,Amos Getanda ,A Mwangi

doi:10.7176/jhmn/65-09

Abstract

Perineal trauma is classified according to the degree of structures involved or according to the depth of the injury. Mild perineal trauma is very common following vaginal delivery. Risk factors for perineal trauma include primiparity, precipitate labour, instrumental deliveries, pushing techniques and birth positions. Perineal trauma is associated with significant short-term and long-term complications. The objective of the study was to determine the prevalence and risk factors for perineal trauma among women at teaching and referral hospital in western Kenya. A cross-sectional study was carried out at the teaching hospital between April and May 2015. Two hundred and nine women who had come to deliver at the facility were consented to participate in the study. A structured checklist was used to obtain data from the women and make observations as skilled care givers attended to deliveries. All analyses were performed at 95% level of confidence. Two hundred and nine (209) deliveries were observed. Majority of the women, 76 (36.40%), were in the 20-24 age group. Ninety seven (46.10%) of them were para 0. Eighty one (38.8%) of the women sustained various types of perineal trauma. Supine position during delivery was the most preferred position, in 201 (96.2%), of the women. Age of the mother, parity, infant birth weight, and history of previous trauma, were statistically significant, associated with trauma in the univariate analysis (p=0.013; p=0.000; p= 0.010; p= 0.033) respectively. Adjusting for other factors, the odds of sustaining perineal trauma increased with increased birth weight (OR 2.878; p= 0.005) and decreased with increasing parity (OR 0.037; p=0.000). The prevalence of perineal tears as revealed by the study was 38.8%. This study recommended evidence based practice during labour and delivery in order to improve pelvic floor outcomes as well as reduce operative deliveries and long term morbidities. Key words: Perineal trauma, Risk factors, Prevalence, Women DOI : 10.7176/JHMN/65-09 Publication date : August 31 st 2019

Highlights

Perineal trauma is damage to the genitalia, which occurs during spontaneous child birth or due to a surgical incision or episiotomy (Johanson, 2000)
In the United Kingdom (UK), occurrence of mild perineal tears is very common among nulliparous women, accounting for 75%, while severe perineal tears are much less common, with prevalence varying between 0.1% and 8% (Jackson, 2000)
Risk factors of developing 3rd and 4th degree tears include nulliparity, precipitate labor, persistent occipito-posterior position, instrumental delivery forceps as compared to vacuum delivery (Melamed et al, 2013), midline episiotomy, macrosomia, shoulder dystocia, epidural anesthesia and prolonged second stage of labor (Kudish et al, 2008)

Summary

Introduction

Perineal trauma is damage to the genitalia, which occurs during spontaneous child birth or due to a surgical incision or episiotomy (Johanson, 2000). Risk factors of developing 3rd and 4th degree tears include nulliparity, precipitate labor, persistent occipito-posterior position, instrumental delivery forceps as compared to vacuum delivery (Melamed et al, 2013), midline episiotomy, macrosomia, shoulder dystocia, epidural anesthesia and prolonged second stage of labor (Kudish et al, 2008) Some practices such as directed pushing, coached or “closed glottis” Valsalva maneuver may injure maternal pelvic floor structures and impair bladder function (Lemos et al, 2011). Meyvis et al, (2012) acknowledge that some risk factors such as nutritional status, maternal body mass index, ethnic origin, birth weight and fetal position, may not be altered during delivery, others such as maternal position may be altered with the possibility of reducing perineal damage Whenever they occur, perineal tears are associated with significant short- and long-term morbidity.

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