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Prevalence and risk factors for third- and fourth-degree perineal lacerations during vaginal delivery: a multi-country study

  1. F Hirayama1,
  2. A Koyanagi1,
  3. R Mori1,
  4. J Zhang2,
  5. JP Souza3,
  6. AM Gülmezoglu3

Article first published online: 12 JAN 2012

DOI: 10.1111/j.1471-0528.2011.03210.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 119, Issue 3, pages 340–347, February 2012

Additional Information

How to Cite

Hirayama, F., Koyanagi, A., Mori, R., Zhang, J., Souza, J. and Gülmezoglu, A. (2012), Prevalence and risk factors for third- and fourth-degree perineal lacerations during vaginal delivery: a multi-country study. BJOG: An International Journal of Obstetrics & Gynaecology, 119: 340–347. doi: 10.1111/j.1471-0528.2011.03210.x

Author Information

  1. 1

    Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

  2. 2

    MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

  3. 3

    Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland

*Dr A Koyanagi, Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033 Japan. Email koyanagiai@yahoo.com

Publication History

  1. Issue published online: 12 JAN 2012
  2. Article first published online: 12 JAN 2012
  3. Accepted 7 October 2011.

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Keywords:

  • Developing countries;
  • multi-country study;
  • third- and fourth-degree perineal lacerations

Please cite this paper as: Hirayama F, Koyanagi A, Mori R, Zhang J, Souza J, Gülmezoglu A. Prevalence and risk factors for third- and fourth-degree perineal lacerations during vaginal delivery: a multi-country study. BJOG 2012;119:340–347.

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.

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