Objective: To investigate the prevalence and risk factors of third- and fourth-degree perineal lacerations in 24, mainly developing, countries.
Design: Analysis using cross-sectional data from the WHO Global Survey on Maternal and Perinatal Health.
Setting: Seven African, nine Asian and eight Latin American countries.
Population: Women at admission to hospital for delivery in 373 facilities between 2004 and 2008.
Methods: We estimated the country-wise prevalence of third- and fourth-degree perineal lacerations, and conducted region-wise multivariate logistic regression analyses to identify its risk factors.
Main outcome measures: Prevalence and risk factors of third- and fourth-degree perineal lacerations.
Results: A total of 214,599 women who underwent vaginal delivery were analysed. The prevalence of third- and fourth-degree perineal lacerations ranged widely across countries [from 0.1% (China, Cambodia, India) to 15.0% (Philippines)] and facilities (from null to 76.3%). After the deletion of facilities reporting no third- or fourth-degree perineal lacerations, and also highly outlying facilities, the range in prevalence was 0.1% (Uganda) to 1.4% (Japan). Forceps-assisted delivery, nulliparity and high birthweight were significant risk factors in all three regions. Vacuum-assisted delivery was also a significant risk factor in Africa and Asia.
Conclusions: Misdiagnosis of third- and fourth-degree perineal lacerations in developing countries may be common. Correct recognition and diagnosis may lead to timely treatment and fewer sequelae. Risk factors of third- and fourth-degree perineal lacerations in developing countries were similar to those previously reported from developed countries.
© 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.