The Incidence and Risk Factors of Third- and Fourth-Degree Perineal Tears in Ministry of Health in Bahrain over 5 Years

Background: Perineal trauma and vaginal laceration are considered a common complication associated with vaginal delivery. Well established risk factors, recognized by the Royal College of Obstetricians and Gynecologists, are ethnicity, birth weight over 4 kg persistent occipital posterior position, null parity, induction of labor, shoulder dystocia, instrumental delivery. There are other risk factors that were suggested in the literature, but data are conflicting, such as prolonged second stage of labor, episiotomy and obesity. Objective: To evaluate third- and fourth-degree perineal rears rates and the impact of related risk factors on perineal tears in Ministry of health in Bahrain over 5 years (which includes Salmanyia Medical complex (SMC) and Jidhafs maternity hospital (JMH)). Methods: This retrospective descriptive cross-sectional study analyzed all vaginal deliveries from January 2015 to December 2019 in Obstetrics and Gynecology department in Salmanyia Medical Complex (the main hospital in Kingdom of Bahrain which received all kinds of cases including low and high risks) and Jidhafs Maternity Hospital (tertiary hospital which received only low risk cases), Kingdom of Bahrain. During the period of interest 33,694 records were identified. Data were extracted from observational recording from SMC and JMH labour registry books. Results: There was no statistically significant difference between groups according to age (p = 0.199). On the other hand, there was statistically significant higher cases of >40 weeks at gestational age, obesity > 35 kg/mr, vacuum delivery, pushing stage > 90 min, birth weight > 4 kg, head circumference > 34 cm, fetal length at birth > 50 cm, episiotomy and lower cases of nulliparity in study group compared to control group 16 (66.7%) vs. 13,805 (41.0%), 3 (12.5%) vs. 1448 (4.3%), 3 (12.5%) vs. 1414 (4.2%), 4 (16.7%) vs. 1751 (5.2%), 3 (12.5%) vs. 1751 (5.2%), 12 (50.0%) vs. 15,926 (47.3%), 15 (62.5%) vs. 20,135 (59.8%) and 17 (70.8%) vs. 29,024 (86.2%);(p = 0.027, 0.009, Conclusion: Gestational age > 40 weeks, obesity > 35 kg/mr, pushing stage > 90 min, birth weight > 4 kg, head circumference > 34 cm, fetal length at birth > 50 cm and using of vacuum increase incidence of 3rd and 4th degree perineal tears with vaginal delivery however maternal age and nulliparity have no significant role. Finally, episiotomy did not represent as protective factor for perineal damage. .

Risk Factors Associated with Obstetric Perineal Tear in a Maternity Ward of the Communal Medical Center of Ratoma-Conakry-Guinea

Introduction: Obstetric perineal tears are a common complication during childbirth. The objectives of this study were to describe the sociodemographic characteristics, the different types of perineal tears and to identify the associated risk factors. Patients and Method: The maternity of the CMC of Ratoma served as a setting for carrying out this study. This was a prospective study of a descriptive and analytical type, which took place over a period of 6 months from July 1, 2021 to January 1, 2022. Results: The frequency of perineal tear was 9%. The average age of the patients concerned was 23.99 years ± 5.18 years, with extremes of 15 and 38 years. Housewives were the most numerous (30.88%). Most of our parturient had undergone excision (99.6%) and they were more frequently primiparous (40.44%) and pauciparous (47.79%). The multiplicity of risk factors was a remarkable fact (scarred perineum, edematous, short, and infected). The presentation was cephalic in 96.33%, posterior variety in 3.81% and the variety of positions could not be specified by the health worker who provided care to the parturient in 46.56%. The expulsion took place in OP (92.37%) and in OS (2.30%). In most cases, midwives carried out deliveries (93%). Perineal tears were 1st degree (54.41%), 2nd degree (39.70%), 3rd degree (5.15%) and 4th degree (0.74%). Conclusion: Prevention of perineal obstetric injuries is based on better knowledge of risk factors and delivery by qualified personnel. The main limitation of this study is the impossibility of highlighting occult perineal lesions due to the weakness of the technical platform.

Therapeutic Use of Hyaluronidase in Obstetrics

Introduction: Hyaluronidases are a group of enzymes that permit greater diffusion of fluid through the tissues. These enzymes have the ability to reduce the viscosity of hyaluronic acid and increase cellular membrane and blood vessel permeability. This review discusses the indication, usage, effects, and safety of hyaluronidases in obstetrics. Materials and Methods: MEDLINE/ PubMed and the Cochrane Library were searched using the following terms: (“hyaluronidase” [Title/Abstract]) OR (“hyaluronidases” [Title/Abstract]) AND (“therapeutic use” [Title/Abstract]) OR (“therapeutic uses” [Title/Abstract]) OR (“perineal trauma” [Title/Abstract]) OR (“perineal tear” [Title/Abstract]) OR (“cervical ripening” [Title/Abstract]). Results: This review included four randomized controlled trials (RCT) that randomized a total of 642 pregnant women and two interventional non-RCTs that included a total of 2824 pregnant women. The data from two RCTs suggested that the incidence of perineal trauma was significantly lower in the intervention (perineal hyaluronidase injection in stage two of labor) than the control group (no intervention). However, both groups did not differ significantly in the incidence of first- and second-degree tears. Similarly, no significant difference in the incidence of episiotomy was found between both groups. In one interventional non-RCT, the administration of intracervical hyaluronidase was associated with a statistically significant acceleration and shortening of labor by approximately 1.95 hours after the injection of intracervical hyaluronidase. However, it had no effect on uterine contractions or the duration of stages two and three labor. Conclusions: While it is safe, clinicians should consider patient acceptance and the effectiveness of hyaluronidase compared to conventional less invasive methods.