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.
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.
Authors: Judith T W Goh; Stephanie B M Tan; Harriet Natukunda; Isaac Singasi; Hannah G Krause Journal: Int Urogynecol J Date: 2016-04-30 Impact factor: 2.894
Authors: Diana Garretto; Brian B Lin; Helen L Syn; Nancy Judge; Karen Beckerman; Fouad Atallah; Arnold Friedman; Michael Brodman; Peter S Bernstein Journal: J Obes Date: 2016-05-05