Prevalence and Risk Factors of Episiotomy and Perineal Tear in the Maternity Teaching Hospital of Erbil City, Iraq

During child birth, tearing to the perineum can occur naturally or by the surgical process of an incision known as episiotomy.Both natural tearing and episiotomy are found to be traumatic to the genitalia *1+.Reported rates of episiotomies vary from as low as 9.7% in Sweden to as high as 100% in Taiwan considering both nulliparous and multiparous women *2,3+.More than 85% of women having a vaginal birth experience some form of perineal trauma, and 60-70% of women receive sutures post-delivery to repair the perineum.Approximately one-third of the women in the United States and the United Kingdom Background and Objectives: During childbirth, women are at risk for experiencing perineal trauma to the genitalia resulting in a tear of the perineum or the surgical process of an episiotomy.Knowing the prevalence and the risk factors associated with perineal trauma may help in the reduction of episiotomy and prevention of occurrence of tear.The aim of the study was to find out the prevalence and risk factors associated with perineal trauma among women ages 15-48.Methods: A cross sectional study was conducted in the Maternity Teaching Hospital of Erbil, Kurdistan region, Iraq.All records of mothers (n = 1500) who had been admitted to the delivery room for vaginal delivery during the month of May (2015) were reviewed.Chisquare test of association and binary logistic regression were used to interpret the data. Results:The overall rates of episiotomy, tear, their combined presence, and an intact perineum were: 47.8%, 7.2%, 26.1% and 18.9%, respectively.Incidence of having an episiotomy, tear, or combination of both, were significantly associated with women of young ages and women who were primigravida parity.There was a statistically significant association between high birth weight and the occurrence of perineal trauma.There was no association between perineal trauma and residency (urban/rural), occupation, gender of baby and time of delivery.Binary logistic regression analysis showed that having an episiotomy increased the risk of a tear by more than 30%.Conclusions: The prevalence of episiotomy was found to be 73.9% which is much higher compared to the World Health Organization recommendation which is 10%.Perineal trauma were associated with factors such as age, parity, and birth weight.Episiotomy is a risk factor for a vaginal tear.We recommend further research to inform the development and implementation of restrictive episiotomy policies to reduce and prevent occurrences of perineal trauma.