VAGINAL BIRTH TRAUMA AND PRIMIPARITY; EXPERIENCE AT A TERTIARY CARE HOSPITAL

Abstract

Objective: To determine the effects of perineal tears during vaginal birth in primiparous
women
Methodology: This Cross-Sectional Study was conducted at the Department of Obstetrics
& Gynae, Unit I, LUMHS, Jamshoro, from October 27, 2022 to April 26, 2023. All
women who fulfilled the inclusion criteria and admitted in emergency in labour ward
were included in the study. Informed written consent was taken after explaining the
procedure, risks and benefits. Data were entered in predesigned proforma containing
basic biodata, sociodemographic details, gestational age, mode of onset of labour
(spontaneous or induced), vaginal delivery with episiotomy, instrumental vaginal
delivery with perineal tears, type I, II, III and IV- degree. All the data were collected and
analyzed on SPSS version-21.
Results: The mean maternal age was 24.86±5.70 years. Among women with perineal
tears, instances of bleeding were noted in 21.1% of 1st degree tears and 24.6% of 2nd
degree tears. Anesthesia-related issues were reported in 7.0% and 14.9% of cases,
respectively. Puerperal sepsis was documented in 4.4% of 1st degree tears and 0.9% of
2nd degree tears. For 3rd degree tears, bleeding was observed in 2.6% of cases, with
anesthesia-related complications reported in 5.3% and puerperal sepsis in 2.6%.
Rectovaginal fistula was not observed in any tear degree, while vesicovaginal fistula was
documented in 0.9% of 1st degree tears and 4.4% of 2nd degree tears. The mean lengths
of hospital and ICU stays were 24.76 ± 15.73 hours and 3.26 ± 1.41 hours, respectively.
In-hospital mortality was noted in 3.3% of participants, and perineal tears were observed
in 37.6% of cases.
Conclusion: The bleeding and anesthesia-related issues were more common in 2nd
degree tears compared to 1st degree tears. Puerperal sepsis was relatively rare but more
frequent in 1st degree tears. Vesicovaginal fistula occurred more frequently in 2nd
degree tears. Mortality was relatively low.
Keywords: Perineal Tears, Primiparity, Vaginal Birth, Morbidity, Mortality