Frequency and severity of perineal tears in Countess Lady Duffrin Fund Hospital, Hyderabad

Department of Obstetrics & Gynaecology, Isra University Hospital, Hyderabad Sindh, Pakistan.
Journal of the Pakistan Medical Association (Impact Factor: 0.41). 08/2012; 62(8):803-6.
Source: PubMed


To observe the frequency and severity of perineal tears during vaginal delivery.
It was a prospective observational study done at the Countess Lady Duffrin Fund Hospital, Hyderabad, Pakistan, from December 1, 2009 to May 31, 2010. Women with full-term singleton pregnancy primigravida or multigravida, in active labour were included in the study. Patients with pre-term labour, breech presentation and antepartum haemorrhage were excluded, leaving the study population to be 147/1488. A predesigned structured proforma was used after informed verbal consent by the patient. All results were analysed on SPSS version 11. Frequencies and percentages were calculated, while Spearman's rho test (two-tailed) was applied for categorical variables. A p-value of less than or equal to 0.05 was considered significant.
The frequency of perineal tears in our study was 147/1488 (9.8%). The mean age was 28.08 +/- 7.47, ranging between 17-42 years. The vast majority, 100 (68%) delivered spontaneously, 45 (30.6%) were delivered with help of the forceps, and only 2 (1.4%) had vacuum delivery. Parity, oxytocin use, mediolateral episiotomy, forceps use, weight of babies > 3.6 kg were significantly associated with perineal tears.
Perineal tears cause considerable post-natal morbidity. Identification of risk factors, vigilant monitoring during labour and good perineal support is recommended for minimising the risk of perineal trauma as well as morbidity.

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    ABSTRACT: In developing countries such as Pakistan, poor training of mid-level cadres of health providers, combined with unregulated availability of labour-inducing medication can carry considerable risk for mother and child during labour. Here, we describe the exposure to labour-inducing medication and its possible risks in a vulnerable population in a conflict-affected region of Pakistan. A retrospective cohort study using programme data, compared the outcomes of obstetric risk groups of women treated with unregulated oxytocin, with those of women with regulated treatment. Of the 6379 women included in the study, 607 (9.5%) received labour-inducing medication prior to reaching the hospital; of these, 528 (87.0%) received unregulated medication. Out of 528 labour-inducing medication administrators, traditional birth attendants (also known as dai) 197 (37.3%) and lady health workers 157 (29.7%) provided unregulated treatment most frequently. Women given unregulated medication who were diagnosed with obstructed/prolonged labour were at risk for uterine rupture (RR 4.1, 95% CI 1.7-9.9) and severe birth asphyxia (RR 3.9, 95% CI 2.5-6.1), and those with antepartum haemorrhage were at risk for stillbirth (RR 1.8, 95% CI 1.0-3.1). In a conflict-affected region of Pakistan, exposure to unregulated treatment with labour-inducing medication is common, and carries great risk for mother and child. Tighter regulatory control of labour-inducing drugs is needed, and enhanced training of the mid-level cadres of healthcare workers is required. © The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.
    08/2015; DOI:10.1093/inthealth/ihv051