Background: Perineal trauma is a common event in obstetrics, affecting up to 90 percent of primiparous and is sometime
associated with considerable post-natal morbidity and mortality . These patients are at an increased risk of recurrent severe
perineal lacerations in subsequent deliveries . Many of these patients develop subsequent anal incontinence and sexual
dysfunction despite an adequate primary sphincter repair .
Objectives: The aim of the study is to highlight the frequency and severity of perineal tears during vaginal delivery which leads
to major physical, psychological and social problems.
Study Design and Methods: This retrospective cohort study analyzed all vaginal deliveries from January 2011 to December
2015 in Security Forces Hospital, Riyadh, Saudi Arabia. The Hospital has around 6000 deliveries per year. Data were extracted from
dedicated database software for antenatal care through Hospital System (Medical Record Viewer MRV) and from Midwife Head
Nurse daily record system. The data used were already available for the analysis for all patients as part of the clinical report of the
Obstetrics and Gynecology Department of Security Forces Hospital.
Results: A total of 28325 patients were admitted for vaginal deliveries. Of them, 406 (1.4 %) patients sustained second, third or
fourth degree perineal tears. Of the 406 patients, 285 (70.1%) were primiparous and 121 (29.9%) were multiparous. The mean age
of the study population was 28.08±7.47, ranging between 17-42 years (Table 1). Of the total, 139 (32%) delivered spontaneously,
while 276 (68%) delivered with the help of vacuum delivery. The primigravida were significantly associated with the frequency of
severe lacerations (p<0.006). Perineal tears were not significantly associated with episiotomy (p<0.623). The occurrence of tears
was in 313 (44.3%) when birth weight > 4 Kg (p <0.001).
Conclusions: Perineal tears cause considerable post-natal morbidity. Identification of risk factors, vigilant monitoring and
supervision by senior doctors during difficult deliveries and good perineal support is recommended for minimizing the risk of
perineal trauma as well as morbidity.