Genital Tract Lacerations in Women Delivered by Medical Doctors at the Niger Delta University Teaching Hospital, Southern Nigeria

Abstract

Background: Lacerations of the genital tract are very common complications encountered during child birth. It could result from the perineal tear, laceration of the vulva, vagina, cervix, or from an episiotomy. Perineal trauma could lead to haemorrhage, which could be profuse and life threatening. Objective: The objective of this study was to determine the pattern and extent of genital tract lacerations among women delivered by medical doctors, using vaginal delivery by nurses as a control. It would also determine whether: maternal age, parity, gestational age at delivery, mode of delivery, birth weight and fetal sex have a significant influence on genital trauma during labour. Materials and Methods: A retrospective observational study of 5,240 parturient who deliver vaginally at the Niger Delta University Teaching Hospital; a total of 1300 cases of genital trauma were identified. These include perineal tears, laceration of the vulva, vagina and cervix, and episiotomies. The case note of these patients was retrieved from the hospital records, and information concerning their bio-data, booking status, gestational age at delivery, mode of delivery, who took the delivery, the estimated blood loss, fetal sex, birth weight, and the pattern and extent of genital trauma was retrieved and analyzed.  The study was carried out from January 2007 to December 2011. Results: The prevalence rate of genital tract lacerations was high at 24.8%; they were predominantly episiotomies (63.7%) and perineal tear (26.5%). Nurses delivered significantly more women in labour than doctor, P = 0.0001, Odds Ratio = 0.32[0.26, 0.39]. Delivery by doctors resulted in significantly higher rate of episiotomies, P = 0.001, Odds ratio = 1.46 [CI, 1.16, 1.84], however first and second degree perineal tears were significantly higher among women delivered by nurses, P = 0.02, Odds ratio = 0.67 [CI, 0.48, 0.94], and P = 0.04, Odds ratio = 0.70 [CI, 0.49, 0.99] respectively. There was no significant difference in the rates of 3rddegree perineal tear, isolated vulva, vaginal and cervical lacerations. Delivery by doctors resulted in more primary postpartum haemorrhage, P = 0.02. With respect to the rank of the accoucheurs, delivery by junior residents resulted in significantly more perineal tear than senior residents. P = 0.004, and the chances of having cervical lacerations were twice higher, Odds Ratio = 2.31(0.83, 6.45). Conclusion: Lacerations of the genital tract are common complications following vaginal delivery at the Niger Delta University Teaching Hospital, of which episiotomies and perineal tear predominate. Since delivery by doctors significantly resulted in less perineal tear; it would be a good idea for doctors to participate more actively in delivering our women. The outcome would even be better if senior doctors are more proactive and committed to the delivery process.