Prevalence and Associated Factors of Severe Degree Perineal Tear at Mekelle Public Hospitals, Tigray, Northern Ethiopia: A Seven Years Review

Abstract

Musie Negasi Gebreslase*, Haftom Guesh, Dawit Negash, Awol yeman, Yibrah Berhe, Amanuel Gessesew, Kidu Gidey and Birhanu Kassie

Introduction and Objectives: Obstetric anal sphincter injuries (OASIS) from perineal trauma during vaginal delivery result in poor maternal health outcomes and are common in low-resource settings and unattended births. Despite skilled hospital staff, some women still experience these injuries. This study evaluates the incidence and risk factors of third and fourth-degree perineal tears at Mekelle Public Hospitals in Tigray, Northern Ethiopia, from July 2016 to June 2023, aiming to fill gaps in understanding in resource-limited environments.

Methodology: An unmatched case-control study was conducted at Mekelle public hospitals in Ethiopia from July 1, 2016, to June 30, 2023. The study compared mothers who experienced severe perineal lacerations during vaginal delivery (cases) with those who did not (controls). All eligible cases from the seven-year period were included, and three controls per case, who delivered on the day of severe laceration repair, were selected. Data on sociodemographic, maternal, fetal, labor, delivery, and health provider characteristics were collected using structured questionnaires. Data were analyzed with epi-Data Management version 4.6 and SPSS version 23, employing bivariate and multivariate logistic regression. Statistical significance was determined with a p-value of <0.05, and associations were measured using odds ratios.

Results: The study included 361 participants (88 cases and 273 controls) with mean maternal ages of 26.2 and 26.9 years, respectively. The prevalence of severe perineal tears over seven years was 0.157% (1.57 per 1,000 vaginal deliveries). Risk factors for severe tears included rural residence, primiparity, gestational age ≥40 weeks, birth weight ≥3.5 kg, and instrumental delivery, while episiotomy was associated with a reduced risk.

Conclusion and Recommendation: At Mekelle Public Hospitals, severe perineal tears during vaginal delivery were linked to primiparity, instrumental delivery, fetal weight ≥ 3.5kg, gestational age ≥ 40 weeks, and rural residence. Mediolateral episiotomy reduced the risk. Regular monitoring and continuous training for birth attendants are essential to improve outcomes.

HTML PDF