Degree Perineal Tears Research Articles

3rd and 4th degree perineal tears that occurs during vaginal delivery

Objective: Perineal injuries are common in vaginal delivery. In this study, we aimed to investigate the factors affecting the degree of perineal injury and the effect of injury degree on incontinence. Methods: Fifteen patients, underwent sphincter repair by the general surgery unit, who had perineal tear during normal vaginal delivery between January 2018 and March 2019 in our hospital and were retrospectively evaluated. Those with grade 3a and 3b perineal tears were divided into 2 groups as group-1, and those with grade 3c and grade 4 perineal tears as group-2. Episiotomy type, fetal characteristics [head circumference and birth weight], early postoperative continence findings were compared in between groups. Results: The average age of the patients was 30 ± 8.7 years. When the groups were compared, there was no significant superiority of episiotomy in terms of perineal injury (p=0.07). 4 patients had 3a, 3 patients had 3b, 6 patients had 3c and 2 patients had fourth-degree perineal injuries. The average birth weight of the newborns was 3438 ± 492 g, and the head circumference was 34.33 ± 1.23 cm. There was no significant difference in incontinence between the groups (p=0.55). Conclusıon: The treatment of anorectal injuries is surgery. The method of treatment varies according to the time elapsed between injury and intervention, fecal contamination, degree of injury, general condition of the patient, presence of accompanying injury, experience and preference of surgeon. We think that sphincter damage during delivery can be looked after successfully with early diagnosis and intervention before tissue edema develops.

Racial variations of adverse perinatal outcomes: A population-based retrospective cohort study in Ontario, Canada.

IntroductionRacial differences in adverse maternal and birth outcomes have been studied in other countries, however, there are few studies specific to the Canadian population. In this study, we sought to examine the inequities in adverse perinatal outcomes between Black and White pregnant people in Ontario, Canada.MethodsWe conducted a population-based retrospective cohort study that included all Black and White pregnant people who attended prenatal screening and had a singleton birth in any Ontario hospital (April 1st, 2012-March 31st, 2019). Poisson regression with robust error variance models were used to estimate the adjusted relative risks of adverse perinatal outcomes for Black people compared with White people while adjusting for covariates.ResultsAmong 412,120 eligible pregnant people, 10.1% were Black people and 89.9% were White people. Black people were at an increased risk of gestational diabetes mellitus, preeclampsia, placental abruption, preterm birth (<37, <34, <32 weeks), spontaneous preterm birth, all caesarean sections, emergency caesarean section, low birth weight (<2500g, <1500g), small-for-gestational-age (<10th percentile, <3rd percentile) neonates, 5-minute Apgar score <4 and <7, neonatal intensive care unit admission, and hyperbilirubinemia requiring treatment but had lower risks of elective caesarean section, assisted vaginal delivery, episiotomy, 3rd and 4th degree perineal tears, macrosomia, large-for-gestational-age neonates, and arterial cord pH≤7.1, as compared with White people. No difference in risks of gestational hypertension and placenta previa were observed between Black and White people.ConclusionThere are differences in several adverse perinatal outcomes between Black and White people within the Ontario health care system. Findings might have potential clinical and health policy implications, although more studies are needed to further understand the mechanisms.

Anal incontinence after a prolonged second stage of labor in primiparous women.

The objective was to investigate the effect of delivery mode on anal incontinence 1–2 years after delivery in primiparous women with prolonged second stage of labor. This population-based cohort and questionnaire study performed in Stockholm Region, Sweden, included 1302 primiparous women with a second stage ≥ 3 h from December 1st, 2017 through November 30th, 2018. Background characteristics and outcome data were retrieved from computerized records. Questionnaires based on Wexner score were distributed 1–2 years after delivery. Risk of anal incontinence, defined as Wexner score ≥ 2, was calculated using logistic regression and presented as crude and adjusted odds ratios (OR and aOR) with 95% confidence intervals (CI). Compared with cesarean section, vacuum extraction was associated with anal incontinence (aOR 2.25, 95% CI 1.21–4.18) while spontaneous delivery was not (aOR 1.55, 95% CI 0.85–2.84). Anal incontinence was independently associated with obstetric anal sphincter injuries (aOR 2.03, 95% CI 1.17–3.5) and 2nd degree perineal tears (aOR 1.36, 95% CI 1.03–1.81) compared with no or 1st degree perineal tear. Obstetric anal sphincter injury at vacuum extraction inferred the highest risk of anal incontinence (aOR 4.06, 95% CI 1.80–9.14), compared with cesarean section. Increasing duration of the prolonged second stage did not affect the risk.

Caesarean section, vaginal instrumental delivery and perineal morbidity in the Slovak Republic in the years 2007-2018.

Analysis of caesarean section, vaginal instrumental deliveries and severe perineal morbidity in the Slovak Republic in the years 2007-2018. The analysis of prospectively collected caesarean section and vaginal instrumental delivery data in the years 2007-2018, and episiotomies and severe perineal morbidity data in the years 2008-2018 from obstetrics hospitals in the Slovak Republic. Caesarean section rate progressively increased from 24.1% in 2007 up to 30.8% in 2013 and decreased to 29.6% in 2018. Vacuum-extraction frequency was 1.3% in 2007 and increased up to 2.0% till 2018. Forceps frequency decreased since 2008-2018 from 0.56% to 0.43%. In the years 2008-2018, frequency of perineal tears of the 3rd and 4th degree increased from 0.4% to 0.8%. Frequency of episiotomies decreased in the years 2008-2018 from 74.7% to 47.7%. The highest caesarean section rate in the Slovak Republic - 30.8% occurred in 2013, but slowly decreased in the following years. The frequency of vacuum extraction increased and forceps decreased. Frequency of episiotomies had decreased and severe perineal tears held an increasing trend.

FREQUENCY OF COMMON FACTORS INFLUENCING THE GRAFT UPTAKE IN MYRINGOPLASTY AMONG THE TERTIARY CARE HOSPITAL KPK

Introduction: Tympanoplasty refers to any operation involving reconstruction of the tympanic membrane and /or the ossicular chain. Myringoplasty is a tympanoplasty without ossicular reconstruction. Over the years many methods have been used for closing perforations. Myringoplasty was introduced by Berthold in 1878 but the modern era began only in 1950s with the work of Wullstein and Zoellner. The study aims to analyse the common factors which are predictive of success of myringoplasty in adult patients and to construct and validate a prognostic index that could be used as tool to predict the success of myringoplasty in adults.&#x0D; Objectives: To determine the frequency of common factors influencing the graft uptake in myringoplasty.&#x0D; Materials and Method: In this study, a total sample size was 376, using 4.08% proportion of fourth degree perineal tear, 95% confidence level and 2% margin of error under WHO software for sample size determination. Moreover, consecutive non probability sampling technique was used.&#x0D; Results: The mean age was 40 years with standard deviation of ± 2.63. Sixty two percent of the patients were male while thirty eight percent patients were female. The success rate of myringoplasty was 90% while the failure rate was 15(10%) patients in which 4(25%) patients had medium perforation, 5(33%) patients had large perforation while 6(42%) patients had subtotal perforation. Regarding the causes of perforation among 15(10%) patients, 13(85%) patients had infection while only 2 patients had trauma.&#x0D; Conclusion: The study concludes that infection (85%) was the most common cause of perforation followed by trauma (15%) in the graft uptake in myringoplasty.

Delivery in water, experiences in a population of Mexican women in Mexico City

Background: Labor is a physiological process during which the fetus, the membranes, the umbilical cord and the placenta are expelled from the uterus and water delivery has become popular, although its prevalence is unknown, it is supported by healthy women with full-term pregnancies, without complications; although there is insufficient evidence to support or discourage it. Objective: To identify obstetric and neonatal outcomes and complications in women who delivered in water and to compare them with traditional deliveries. Material and methods: It is a retrospective, observational and cross-sectional study, where 2486 women were included from a database of 4223 women assisted from 2004 to 2020 in private hospitals; Of the 2486 patients included, 1025 had a water delivery and 1461 had a conventional delivery, discarding 1737 women who underwent caesarean section from the study. The information obtained from the patients, their data obtained for this study were kept in the anonymity of the patients, where they were analyzed: non-parametric data reported in percentages using Chi square; Parametric, perinatal and neonatal data are reported as mean plus standard deviation (±SD) and analyzed using Student's T, using the SPSS version 25 statistical package. Results: A total of 2486 women were included in this study, the birth in 1025 was water delivery (24%) and 1461 was conventional delivery (35%), 1737 caesarean section (41%) were excluded from the study, no difference was observed maternal age; unlike weight, height, body mass index; they were higher in women with water birth compared to conventional. No difference was demonstrated between nulliparous (45.99%) and multiparous (53.86%) when comparing both birth in water and conventional; only increase in previous caesarean sections (9.36 vs 6.5%, p=0.008) and decrease in previous abortions (16.19 vs 20.94%, p=0.002) in water delivery with the conventional one; complications were not different: administration of oxytocin (3.2 vs 3.1) or postpartum hemorrhage (0.29 vs 0.13) in both deliveries; no differences in first degree perineal tears (21.4 vs 18.5%). Conclusion: Water birth reduces stress, pain sensation, second and third degree perineal lacerations and contributes to better newborn outcomes; the selection and inclusion of patients with low-risk pregnancies allows better perinatal results than conventional delivery; but, further studies are required to use it routinely.

Pengetahuan dan Perilaku Pencegahan Infeksi Luka Jahitan Persalinan Grade 2 dengan Antibiotik - Laporan Kasus Ibu dengan Kehamilan Berisiko Tinggi

Fetal breeching presentation is position of fetus with his bottom-first in the maternal’s uterus. It will increase risk of perinatal or neonatal mortality and morbidity, if breech presentation persisted at term. During labor, a woman could experienced perineal tears wound due to the impact of contraction pressure on intact perineum – especially for primiparous woman and heavier birth weight – as well as to episiotomy. The degree of perineal tears wound are classified as the first and second grade which are being considered as at low risk of infection and there is no indication of prophylactic antiobiotics; while the third and fourth degree perineal trauma are compulsory to be given antibiotics due to the higher risk of infection. This is cases of two multiparous women whose maternal status during antenatal care presented at Puskesmas – a pirmary healthcare facility in Indonesia – one patient with breech position at weeks 29- 34 and the other one was on chonic energy deficiency who were constantly in low blood pressure (BP) of 100/60 mmHg, MAP 73,3 mmHg, and poor nutritional state. The patients came from low social-economic and education. Healthcare team at Puskesmas provided childbirth education including perineal tears wound care, and pharmacist served medication literacy assistance due to lack of knowledge about their medication administration. This pharmacist’s assistance was delivered on hybrid system due to Covid-19 pandemic. The patient managed to deliver the baby on vaginal birth with second degree perineal tears and started on antibiotics, analgesics, vitamin A, and iron tablets. One of the patient presented with fever, BP of 90/60 mmHg, and wound infection on day-3 postpartum; thus received another cure of antibotics and analgesic. The patients’ knowledge were improved, drug compliance were 100%, perineal tears wound care had been done properly, so that the wound completely dried and healed on day-42 postpartum. Keywords: antibiotics, high risk, perineal wound, knowledge, behaviour.

Enema Administration During Labor: Pregnant Women's Perspective and Knowledge.

Current evidence does not support the routine use of rectal enemas (REs) because they have not been associated with reduced rates of puerperal infection, degree of perineal tear, or duration of labor. A recent literature review recognized knowledge gaps regarding the uses of RE during labor including women's perceptions, pain, and satisfaction. To report pregnant women's knowledge, attitudes, perceptions, pain, and satisfaction associated with the use of RE during labor. A prospective study was conducted between 20 October 2019 and 20 October 2020. Women were included if they were 37 weeks or more pregnant, had a viable pregnancy, were admitted in labor, and had an RE. Characteristic data and data about knowledge, perceptions, attitudes, pain, and satisfaction associated with its use were recorded. Women were regrouped based on their level of knowledge into low- and high-level groups. Attitudes, perceptions, inconveniences, pain, and satisfaction were regrouped into two categories: low and high on the Likert scale. A total of 300 women were recruited, with means (SD) for age and gestational age of 27.8 (4.8) years, and 40 (1.1) weeks, respectively, and 45.7% were knowledgeable or very knowledgeable, 76% had a positive attitude, and 88.7% perceived enemas as important. The mean scores (SD) for pain and satisfaction as measured on visual analogue scales were 1.5 (1.8) and 5.4 (1.8), respectively. Women with high knowledge about RE were older and multiparous. Recruited women were more likely to report lower inconvenience and pain scores and higher satisfaction scores (all P<.05). Most recruited women were knowledgeable about REs, perceived them as important, and expressed a positive attitude toward their administration. The low levels of inconvenience, pain, and complications and the high satisfaction rates may be used when counseling women about when an RE is required during labor.

Effect of Preemptive Episiotomy in Prevention of Perineal Tears in Multiparous Women with High Striae Gravidarum Score: A Randomized Controlled Study

Abstract Objective: To evaluate the effect of preemptive episiotomy in the prevention of perineal tears (PT) in multiparous women with high striae gravidarum (SG) score. Methods: A randomized controlled study (Clinical Trials.Gov: NCT02717676) included multiparous women with singleton full-term pregnancy. SG score was assessed according to Atwal score at four body sites (Abdomen, breast, buttocks, hips). Women with total score >12 were randomized to Group (A): episiotomy was done after crowning of the fetal head during the second stage of labour and Group (B): no episiotomy was done. The primary outcome was the rate of third and fourth degree perineal tears. Results: Two-hundred fifty women were included in the study (125 in each arm). The overall incidence of PT was significantly high in group (B) than group (A) (90.4% Vs. 23.5%respectively, p < 0.001). In addition, the incidence of third and fourth-degree perineal tears was significantly higher in group (B) (15% Vs. 3.3%, p = 0001). Similarly, the incidence of first and second-degree perineal tears was significantly higher in group (B) (75.4% vs. 20.2%, p = 0.001) than group (A). Conclusion: Preemptive episiotomy in multiparous women with high SG score seems to be an effective strategy in prevention of perineal tears during vaginal delivery, especially the third and fourth-degree tears.

Hubungan Paritas dengan Kejadian Rupture Perineum pada Persalinan Normal

Introduction: Even though labor was going normally, after giving birth the mother had various risks of complications that might occur, such as bleeding due to uterine atony, retained placenta, and perineal ruptur. Objective: to see the relationship between parity and the incidence of perineal ruptur in normal delivery. Methods: this type of research uses an analytical method based on a cross sectional design. The population is all mothers who give birth at the Kassi Kassi Health Center Makassar City can use 30 people. The sampling technique used was Consecutive Sampling. Results: The results showed 76.7% of respondents experienced perineal tears, of which 26.7% of respondents experienced 1st degree perineal tears and 50.0% of respondents had grade 2 perineal tears. 23.3% of respondents did not experience perineal tears. From the results of the chi-square test with a value of p=0.05, the probability of the result is greater than a significant tarf of 5% (0.071&gt; 0.05), meaning that there is no parity relationship with perineal tears in mothers with normal delivery at the Kassi-Kassi Community Health Center, Makassar City. 2020. The strength of the relationship between variables is rather low, the value of the Phi coefficient (μ) = 0.488 or 48.8%. Conclusion: Based on the results of the research that has been done, it can be denied that there is no relationship between parity and perineal tearing in normal delivery.

Immediate postpartum assessment of the anal sphincter by endovaginal ultrasound: a new technical approach.

In this study we described a new technical approach to adapt endovaginal ultrasound scanning of the anal sphincter complex to the immediate postpartum period. We analyzed the clinical and ultrasonographic examinations of 18 primiparous women presenting deep perineal tears with potential or clearly identified lesions of the anal sphincter. Potential anal sphincter lesion was defined as a second degree perineal tear extending close to the anal sphincter with exposition of its capsule or muscular fibers. We reported interesting ultrasonographic images explaining our technique in a video. We reported clinical and ultrasonographic features in nine cases of grade 2, four cases of grade 3a, four cases of grade 3b and one case of grade 3c perineal tears. The ultrasonographic examination confirmed the intact state of the anal sphincter complex in all patients with clinical grade 2 tears except one in which a grade 3b lesion was detected. We were not able to identify external anal sphincter lesions on ultrasound in any of the patients with clinical grade 3a tears. In patients with clinical grade 3b tears, the ultrasound confirmed the external anal sphincter lesion in all cases, but revealed additional involvement of the internal anal sphincter in 1 case (grade 3c). Immediate postpartum endovaginal ultrasound could be a promising technique to improve the management of perineal traumas after vaginal delivery.

Association between birth weight and head circumference and obstetric anal sphincter injury severity

ObjectiveTo identify risk factors for increasing severity of OASI and evaluate its possible correlation with two known risk factors–birth weight (BW) and neonatal head circumference (HC). MethodsWe performed a retrospective cohort study at a university affiliated hospital between 2003 and 2019. We compared five groups of patients – according to presence and degree of perineal laceration – 3a, 3b, 3c and 4 and patients without OASI. Additionally, four parameters were defined to assess their relation to the severity of OASI: (1) BW ≥ 90th and HC < 90th percentiles; (2) BW < 90th and HC ≥ 90th percentile; (3) BW and HC ≥ 90th percentile and (4) BW and HC < 90th percentiles. ResultsDuring the study period, 150,221 deliveries were evaluated. Parturients were allocated according to OASI severity − 455 patients had a 3rd (3a, 3b or 3c) or 4th degree perineal tear, while 110,966 patients had no OASI. Allocation to subgroups according to offspring anthropomorphic measures showed that as fetal size parameters increased, the rate of more severe tears increased, particularly in women delivering neonates with HC ≥ 90th percentile.Multinomial regression analysis was performed for each 3rd degree OASI subgroup. This analysis demonstrated the odds for OASI gradually increase with tear severity for BW ≥ 90th percentile and the combined BW and HC ≥ 90th percentile parameters, as compared with neonates with HC and BW < 90th percentile. ConclusionsBirth weight and head circumference above the 90th percentile are correlated with increased degree of OASI severity.

Obstetric anal sphincter injury in adolescent mothers

BackgroundObstetric anal sphincter injury (OASI) is a debilitating complication of vaginal delivery which has yet to receive ample attention in adolescents. The aim of this study was to describe risk for OASI in adolescent mothers compared to adults. We further attempted to compare risk factors for OASI between these two age groups.MethodsWe performed a retrospective cohort study between 2003 and 2019. Primiparous women who delivered vaginally, 21 years and younger were compared to women ages 26–35. Excluded were preterm, multifetal, non-vertex, cesarean deliveries as well as intrauterine fetal death. Rate of OASI as well as obstetric and labor characteristics of women with OASI, were compared between groups. Finally, risk factors were assessed for each group separately. Univariate and multivariate logistic regression model were performed.ResultsFinal analysis was performed on 5113 nulliparous adolescents and 13,845 nulliparous in the 26–35 age group. Allocation to study groups was according to OASI – Sixty-seven adolescents (1.3%) had a 3rd or 4th degree perineal tear and were defined as the OASI group, while 5046 patients (98.7%) did not have such a tear. In the adult group, 199 out of 13,845 patients (1.4%) were diagnosed with OASI. Occurrence of OASI did not differ between groups (p = 0.510). Comparison of women with OASI in the adolescent group vs. adult group found differences with regard to operative vaginal delivery, (20.9% vs. 36.2%, respectively; p = 0.023) and meconium stained amniotic fluid (9.1% vs. 21.3%, respectively; p = 0.027).Following multivariate analysis the only parameter independently associated with OASI in the adolescent age group was head circumference ≥ 90th percentile with an adjusted odds ratio of 3.08 (CI 1.48–6.38, p = 0.003). In the adult group the similar analysis revealed operative vaginal delivery (OR = 2.44, CI 1.72–3.47, p < 0.001) and a birthweight≥90th percentile (OR = 2.23, CI 1.19–4.18, p = 0.012) to be independent risk factors for OASI.ConclusionAdolescents have similar risk for OASI compared to adults but differ in risk factors leading to OASI. Head circumference ≥ 90th percentile was found to be associated with OASI in this age group.

Diagnosis and Treatment of Obstetric Anal Sphincter Injuries: New Evidence and Perspectives.

Perineal injury during childbirth is a common event with important morbidity associated in particular with third-and-fourth degree perineal tears (also referred to as obstetric anal sphincter injuries—OASIS). Early diagnosis of these damages is mandatory to define a prompt therapeutic strategy and thus avoid the development of late-onset consequences, such as faecal incontinence. For this purpose, various diagnostic exams can be performed after a thorough clinical examination. The management of OASIS includes several measures and should be individualized according to the timing and features of the clinical presentation.

Risk Factors in Third and Fourth Degree Perineal Tears in Women in a Tertiary Centre: An Observational Ambispective Cohort Study.

Objectives: To analyze the main risk factors associated with third and fourth degree postpartum perineal tears in women attended to in our obstetrics service. Methods: An observational, retrospective, hospital cohort study was carried out in women whose deliveries were attended to in the obstetrics service of the Hospital General Universitario Gregorio Marañón de Madrid (HGUGM), during the period from January 2010 to April 2017. Results: During the study period, a total of 33,026 patients were included in the study. For maternal variables, the associated increased risk of severe perineal tearing in nulliparous women is OR = 3.48, for induced labor OR = 1.29, and for instrumental delivery by forceps OR = 4.52 or spatulas OR = 4.35; for the obstetric variable of episiotomy, it is OR = 3.41. For the neonatal variables, the weight of the newborns has a directly proportional relationship with the risk of severe tears, and for birth weights of 3000 g (OR = 2.41), 3500 g (OR = 1.97), and 4000 g (OR = 2.17), statistically significant differences were found in each of the groups (p < 0.05). Conclusion: Primiparity, induction of labor, episiotomy, instrumental delivery with forceps or spatula, and a birth weight of 3000 g or more are significantly associated with an increased risk of third and fourth degree perineal tears.

EFFECT OF MATERNAL BODY MASS INDEX ON PROGRESS AND OUTCOME OF LABOR IN NULLIPAROUS PREGNANT WOMEN

Background: Obesity is a widely spread health problem the complications of which are too many whether general or obstetric complications. Objective: The aim of this observational study is to evaluate the impact of increased BMI of nulliparous women on progress of labor, incidence of peri-partum complications (1ry outcome) and neonatal outcome of these women (secondary outcome). Patients and Methods: In this prospective observational study, 150 primigravidas in labor were recruited in Mit Ghamr General Hospital between November 1st, 2019 and April 30th, 2020 and categorized into 5 groups according to WHO BMI classification; Group A contained 50 patients with BMI 18.9-24.9, group B 50 patients with BMI 25-29.9, group C1 20 patients with BMI 30-34.9, group C2 20 patients with BMI 35-39.9 and group C3 10 patients with BMI at least 40. Recruited patients were monitored for their progress of labor (in terms of time of cervical dilation from 4 cm to 10 cm, the accordingly calculated rate of cervical dilation and duration of head descent) and their development of peri-partum complications (cervical dystocia, shoulder dystocia, arrest of head descent, the subsequent potential need for CS, 3rd and 4th degree perineal tears, 1ry post-partum hemorrhage, retained placenta). Neonatal outcome was observed by measuring fetal birth weight, APGAR score at 1 minute and 5 minutes, subsequent potential need for NICU admission and occurance of neonatal jaundice. Results: A statistically significant difference was found regarding progress of labor and neonatal outcome with women in obese groups (C1, C2, C3) having slower progress and worse neonatal outcome, while no statistically significant difference was found regarding mode of delivery and peri-partum complications. Conclusion: Obese women in labor considered high-risk cases that required special measures whether on short-term or long-term basis.

Prevalence and outcome of teenage pregnancy among attendants of labour room in Bassion general hospital-Egypt (cross section study)

ABSTRACT Background: Teenage pregnancy is a global serious public health and distressing social problem, its prevalence varies among countries and among cities of the same country. Teenage mothers are exposed to maternal morbidity and mortality than women in their twenties. Objective: to assess prevalence of teenage pregnancy and their perinatal outcomes & immediate postpartum complications. Methodology: A cross -sectional study was conducted at a hospital that provides medical services to a rural area in Egypt, for six months period, started from 1st December 2019 till 1st June 2020. All women consecutively recruited were either full or preterm, singleton or multiple pregnancy. They were admitted in active labour at the delivery ward of Bassion general hospital. All demographic, prenatal and postnatal data during study period were recorded and tabulated. Results: All pregnant women who were admitted in active labour within the chosen period were 848 women, 73.6% were adults (>19 years, mean 24.06years), 26.4% were teenagers (≤ 19 years, with a mean 17.5 years). Iron deficiency anemia was the most prevalent medical complication in the teenage group 54%, followed by pregnancy induced hypertension (PIH) 21.4%, caesarean section rate was 47 % and perineal tears were recorded in 25.9 % of the teenage group. Most of them had 2nd and 3rd degree tears. 25.9% of the newborns were admitted to the neonatal intensive care unit (NICU), 4.9% due to prematurity, 4.5% due to prematurity and respiratory distress (RDs) and sepsis, 3.6% due to prematurity and RD, 1.3% due to RD ,0 4% due to meconium aspiration, 4.5% due to hyperbillirubinemia and 3.1% due to cyanosis. Conclusion: Teenage pregnancy is prevalent in this study sample in a rural area in Egypt and is associated with an increased risk of major degree perineal tear, PIH, preterm labour and iron deficiency anemia.

Perineal Injury and Its Association with Postpartum Sexual Dysfunction among First Delivery Women

Background: Female sexual dysfunction (FSD) following childbirth imposes significant burden to the marital institution around the world. The perineal injury may potentially be one of the main risk factors contributing to postpartum female sexual dysfunction (PPFSD). The study aimed to determine the effect of perineal injury and patients’ characteristics on PPFSD.&#x0D; Methodology: This cross-sectional questionnaire study was conducted in six different health clinics in the district of Kuantan from April 2019 to October 2019. Eligible women who came to the family health clinics at 6 months postpartum were recruited as study population. The participants completed their biodata and socio-demographic form and the Malay-validated Female Sexual Function Index (MVFSFI) questionnaire given. A cut-off point of 26.55 and below on MVFSFI scoring system was used as a measure of the primary outcome of sexual dysfunction.&#x0D; Results: Out of 240 women who delivered vaginally, 34 (14%) had intact perineum, 107 (44.6%) sustained 1st degree perineal tear, 96 (40%) 2nd degree tear and three (1.25%) 3rd degree tear. Among the respondents, 60.9% of the sexually active respondents who had vaginal delivery, reported to have PPFSD. The timing of sexual resumption does not correlate with the severity of perineal tear. The severity of perineal tear is significantly associated with age (p=0.018), duration of marriage (p=0.008), body mass index (BMI) (p=0.019) and instrumental delivery (p=0.025). The level of personnel skill whom performed the repair were also found to have a significant relationship to PPFSD (p= 0.001). The relationship of participants’ mean age (p=0.271), marriage duration (p=0.903), race (p=0.928), religion (p=0.852), education level (p=0.549), employment status (p=0.102), family income (p=0.460) and BMI(p=0.159) with presence of PPFSD were all found to be statistically not significant.&#x0D; Conclusion: Occurrence of PPFSD is high among sexually active women who had vaginal delivery complicated by perineal tear, especially among those requiring instrumentation. The severity of perineal tear is associated with age, duration of marriage, BMI and mode of delivery. However, PPFSD does not significantly relate to the severity of perineal tear. None of the socio-demographic factors show a significant difference to sexual dysfunction.

P.81 Peri-operative analgesia for third degree perineal tear repairs

P.81 Peri-operative analgesia for third degree perineal tear repairs

Intrapartum interventions and outcomes for women and children following induction of labour at term in uncomplicated pregnancies: a 16-year population-based linked data study

ObjectivesWe compared intrapartum interventions and outcomes for mothers, neonates and children up to 16 years, for induction of labour (IOL) versus spontaneous labour onset in uncomplicated term pregnancies with live...