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

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.