Magnitude of spontaneous perineal tear and associated factors among women receiving delivery services at Arba Minch General Hospital, Southern Ethiopia: An observation-based cross-sectional study
DOI:
https://doi.org/10.69614/ejrh.v17i3.920Keywords:
Arba Minch, Associated factors, Spontaneous perineal tear.Abstract
Background: Spontaneous perineal tear occurs in 79% of women who give birth vaginally, leading to pelvic floor dysfunction and a low quality of life. Identifying factors that contribute to perineal tears can aid in the development of prevention strategies. However, the magnitude and factors associated with spontaneous perineal tears have not been adequately studied in Ethiopia, particularly in this study area. Therefore, this study aimed to assess the magnitude of spontaneous perineal tears and associated factors among women receiving delivery services at Arba Minch General Hospital.
Materials and Methods: A facility-based cross-sectional study was conducted on 398 laboring women from April 1 to July 30, 2021. The participants were selected via a systematic random sampling technique. Data were collected via a structured interviewer-administered questionnaire, data extraction, and an observation checklist. Binary logistic regression analysis was performed to identify factors associated with spontaneous perineal tears.
Results: The magnitude of spontaneous perineal tears was 37.4% (95% CI: 32.7%, 42.2%). Assisted vaginal delivery (AOR = 4.27; 95% CI = 1.21–15.01), duration of the 2nd stage of labor >60 minutes (AOR = 4.55; 95% CI = 2.23–9.15), mediolateral episiotomy (AOR = 4.63; 95% CI = 1.60–13.36), birth weight >3500 grams (AOR = 2.16; 95% CI = 1.10–4.26), applying fundal pressure (AOR = 7.65; 95% CI = 3.52–1665), having female genital cut scars (AOR = 5.23; 95% CI = 1.10–4.54) and perineal support (AOR = 2.23; 95% CI = 1.1–4.54) were factors associated with spontaneous perineal tear.
Conclusions: The magnitude of spontaneous perineal tears in this study was high. Assisted vaginal delivery, episiotomy, birth weight, duration of the second stage of labor, female genitalia cutting, fundal pressure, and perineal support were factors associated with spontaneous perineal tears. Therefore, to reduce its incidence in the future, improving perineal tear prevention strategies is essential.
References
REFERENCES1. United Nations Children’s Fund, The State of the World’s Children 2023: For every child, vaccination, UNICEF Innocenti – Global Office of Research and Foresight, Florence, April 2023. Available at: https://www.unicef.org/reports/state-worlds-children-2023.2. WHO Recommendations: Intrapartum care for a positive childbirth experience. Geneva: World Health Organization; 2018. 3. Arnold MJ, Sadler K, Leli K. Obstetric lacerations: prevention and repair. American Family Physician. 2021 Jun 15;103(12):745-52.4. (RCOG) RC of O and G. The Management of Third- and Fourth-Degree Perineal Tears. Green-top Guidline No. 29. 2015. 5. Maria V, Lins L, Barros F, Vasconcelos L, Coutinho I, Amorim M. Factors associated with spontaneous perineal lacerations in deliveries without episiotomy in a university maternity hospital in the city of Recife , Brazil. 2018;(March). 6. Aguiar M, Farley A, Hope L, Amin A, Shah P, Manaseki S. Birth-Related Perineal Trauma in Low- and Middle-Income Countries : A Systematic Review and Meta-analysis. Matern Child Health J. 2019;23(8):1048–70. 7. Kituku J, Getanda A, Mwangi A. Prevalence and Risk Factors for Perineal Trauma among Women at a Teaching and Referral Hospital in Kenya. Journal of Health, Medicine and Nursing. 2019;65(2012):66–72. 8. Alnakash AH, Jafar S, Abdul-raheem Y. Whether Selective or Routine Episiotomy is More Useful to Protect Anal Sphincter in Primiparous Women. THE IRAQI POSTGRADUATE MEDICAL JOURNAL. 2012;11(1):26–32. 9. Fukami T, Koga H, Goto M, Ando M, Matsuoka S, Tohyama A, Yamamoto H, Nakamura S, Koyanagi T, To Y KH. Incidence and risk factors for postpartum hemorrhage among transvaginal deliveries at a tertiary perinatal medical facility in Japan. PLoS One. 2019;14(1):1–8. 10. Sundquist J christer. Long-term outcome after obstetric injury : Acta Obstet Gynecol Scand. 2012;91(6):715–8. 11. Huebner M, Gramlich NK, Rothmund R, Nappi L, Abele H, Becker S. International Journal of Gynecology and Obstetrics Fecal incontinence after obstetric anal sphincter injuries. International Journal of Gynecology and Obstetrics. 2013;121(1):74–7. 12. Mota RL. Female urinary incontinence and sexuality. 2017;43(1):20–8. 13. Edozien LC, Gurol?Urganci I, Cromwell DA, Adams EJ, Richmond DH, Mahmood TA van der MJ. Impact of third? and fourth?degree perineal tears at first birth on subsequent pregnancy outcomes 2014.pdf. BJOG. 2014;121(13):1695–703. 14. Smith LA, Price N, Simonite V, Burns EE. Incidence of and risk factors for perineal trauma : a prospective observational study. BMC Pregnancy Childbirth. 2013;1–9. 15. Abedzadeh-kalahroudi M, Talebian A, Sadat Z. Perineal trauma : incidence and its risk factors. J Obstet Gynaecol (Lahore). 2018;0(0):1–6. 16. Souza JCD. Risk factors for perineal trauma in the primiparous population during non-operative vaginal delivery. 2019; 17. OECD (2019). Health at a Glance 2019: OECD Indicators, OECD Publishing. Paris; 2019. 18. Aasheim V, Nilsen AB, Reinar LM LM. Perineal techniques during the second stage of labour for reducing perineal trauma (Review). Cochrane Database of Systematic reviews. 2017;(6). 19. Library WRH. WHO recommendation on techniques for preventing perineal trauma during labour. Geneva: The WHO Reproductive Health Library; 2018. p. 1–14. 20. Frolich J, Kettle C. Perineal care Search date November 2013 Pregnancy and childbirth Perineal care. BMJ Clin Evid. 2015; (November 2013):1–23. 21. Egbe TO, Kadzem LN, Takang WA, Tchounzou R EE. Prevalence and Risk Factors of Perineal Tears at the Limbe Regional Hospital , Cameroon. International Journal of Reproduction, Fertility & Sexual Health (IJRFSH). 2016;3(3):70–8. 22. Mathias G, Lawrence K. Risk Factors for Perineal Tears Among Women Delivering at Kawempe National Referral Hospital , Uganda : A Case Control Study. 23. Gj H, Jp V, Cuthbert A, Singata M. Fundal pressure during the second stage of labour ( Review ). 2017; 24. Aquino CI, Saccone G, Troisi J, Guida M, Zullo F, Berghella V. Is Ritgen’s maneuver associated with decreased perineal lacerations and pain at delivery? Journal of Maternal-Fetal and Neonatal Medicine. 2019;0(0):3185–92. 25. Lemos A, Amorim MM, Dornelas de Andrade A, de Souza AI, Cabral Filho JE, Correia JB. Pushing/bearing down methods for the second stage of labour. Cochrane Database of Systematic Reviews. 2017;2017(3). 26. Dystocia S. Practice Bulletin No. 178 Summary: Shoulder Dystocia. Obstetrics and gynecology. 2017;129(5):961–2. 27. Rodrigues S, Silva P, Agius A, Rocha F, Gross M, Calleja-agius J. Intact Perineum : What are the Predictive Factors in Spontaneous Vaginal Birth ? 2019;31(7):25–30.
Ethiopian Journal of Reproductive Health (EJRH) July, 2025 Volume 17, No. 3 3528. Jansson MH, Franzén K, Hiyoshi A, Tegerstedt G, Dahlgren H, Nilsson K. Risk factors for perineal and vaginal tears in primiparous women – the prospective POPRACT-cohort study. BMC Pregnancy Childbirth. 2020;20(1):1–14. 29. Oliveira LS, Brito LG, Quintana SM, Duarte G MA. Perineal trauma after vaginal delivery in healthy pregnant women. Sao Paulo Medical Journal. 2014;132(4):231–8. 30. Ahmed HM, Abdollah WH. Prevalence and Risk Factors of Episiotomy and Perineal Tear in the Maternity Teaching Hospital of Erbil City, Iraq. Erbil Journal of Nursing & Midwifery. 2019;2(1):44–50. 31. Argaw M, Mesfin Y, Demissie E. Birth-Related Perineal Tear and Its Associated Factors Among Mothers Who Delivered in Atat Hospital. Int J Childbirth. 2022;12(2):107–13. 32. Hamed A, Mohamed G. Risk Factors for Birth Related Perineal Truama among Low Risk Parturient Women and Nursing Implications. 2016;5(1):40–8. 33. Naidoo TD, Moodley J. Obstetric perineal injury : risk factors and prevalence in a resource-constrained setting. Trop Doct. 2015;45(4):252–4. 34. Gebremicheal K, Alemseged F, Ewunetu H, Tolossa D, Ma A, Yewondwessen M, et al. Sequela of female genital mutilation on birth outcomes in Jijiga town , Ethiopian Somali region : a prospective cohort study. BMC Pregnancy Childbirth. 2018;18(1):305. 35. Al Hanouf Al Thaydi, Thamer Al Ghamdi ATC and EEM. Perineal Tears Incidence and Risk Factors ; A Four Years Experience in a Single Saudi Center. Interventions In Gynaecology And Women’s Healthcare. 2018;1(5):100–3.
