Obstetric perineal injury: risk factors and prevalence in a resource-constrained setting

The prevalence of obstetric perineal injuries and risk factors vary between affluent and resource-constrained settings. This prospective observational study reports on the factors associated with perineal lacerations in a cohort of Black African and Indian women delivering at two regional hospitals in South Africa. Binary logistic regression analysis was used to test for associations between independent variables and the dependent variable on multivariate analysis. All variables significant on bivariate analysis (P < 0.05) were included in the multivariate model. There were 202 (16.2%) perineal tears. Variables significant with having a perineal tear on bivariate and multivariate analysis included: Black African race (OR: 2.4; 95% CI: 1.2-4.6); duration of labour ≥6.3h (OR: 1.5; 95% CI: 1.1-2.1); and epidural analgesia (OR: 2.9; 95% CI: 1.9-4.7). Having an episiotomy was protective against perineal tears (OR: 0.06; 95% CI: 0.03-0.1). Obstetric perineal injury commonly occurs in our resourced-constrained setting and the risk factors are similar to those in well-resourced settings. Identification of those at risk may reduce obstetric perineal injury.