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.