Perinatal Risk Factors Associated With Intrapartum Perineal Injuries At The Korle Bu Teaching Hospital

Abstract

Background: Obstetric perineal injury is a major contributor to women’s reproductive health problems. More than 60% of women suffer varying degrees of obstetric perineal injuries during vaginal delivery requiring repair. This study determined the risk factors
associated with perineal injury. 
Method: Prospective observational study of 356 women who had singleton term vaginal delivery between 1stApril and 31stMay, 2018 at the KBTH. Sociodemographic and clinical data of participants were collected and analysed to determine association between
variables. A p-value of <0.05 was considered statistically significant.
Results: Two hundred and thirty-six women (66.29%) had vaginal deliveries with no perineal injuries comprising 81 primiparous and 155 multiparous women. Perineal injury among the study participants were 120/356 (33.71%) while perineal injury for first degree, second degree, third degree and fourth degree were 75/356 (21.07%), 41/356 (11.52%), 2/356 (0.56%), 2/356 (0.56%) respectively. A total of 948 vaginal deliveries was conducted during the study period. The odds of developing a perineal injury was 8 times higher among participants with previous surgery on genital tract (OR, 8.29 [95% CI 2.69- 25.6]; p<0.001) and 18 times higher among participants with previous postpartum complication (OR, 18.00 [95% CI 4.06-79.71], p<0.001). Babies with birth weights ≥2.5kg had 4.11 increased odds of developing perineal injury when compared to those with birth weights <2.5kg (OR, 4.11 [95% CI, 1.70-9.98] p=0.001). Vacuum delivery was strongly associated with a 4.81 odds perineal injury (OR, 4.81 [95% CI, 1.22-18.9] p<0.014).
Conclusion: The incidence of perineal injury among women who had vaginal delivery at the KBTH maternity during the study period of (12.66%) was high compared to other studies from the West African Subregion. Risk factors such as previous postpartum complication, episiotomy, and gestational age at delivery, head circumference of the baby, asthma, hypertension and past genital tract surgery were
significantly associated with perineal injury. Early identification of women at risk of perineal injury could help with interventions to reduce the incidence of this complication during childbirth.