TITLE:
Prevalence, Associated Risk Factors and Maternal Outcomes of Lower Genital Tract Injuries in the Bamenda Regional Hospital
AUTHORS:
Takang Ako Wiliiam, Leke J. I. Robert
KEYWORDS:
Genital Tract, Episiotomy, Prevalence, Perineum, Cervix, Vagina
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.12 No.5,
May
31,
2022
ABSTRACT: BACKGROUND: Tears of the genital tract are lesions resulting
from the breakage of the continuity of the lower genital tract during
childbirth. These injuries are associated with high maternal morbidity or
mortality if severe, poorly managed or
delayed in repair. It is a frequent complication of vaginal delivery. This
study was aimed at determining the prevalence, demographic characteristics,
risk factors, patterns and the t-term maternal outcomes of lower genital tract
injuries in the labour room and the post-natal ward of the Bamenda Regional
Hospital. METHODS: This was a hospital-based cross-sectional
study of women managed for genital tract injuries following vaginal birth in
the Bamenda Regional Hospital (BRH) from March 2019 to July 2019. A
non-probabilistic, consecutive and exhaustive sampling technique was used to
select participants (sample size estimated at 237). Among those selected were
women who had a vaginal birth. However, the researchers’ interest was
particularly centered on the women who had genital tract injuries. Data was collected
using a pretested questionnaire and analyzed using the SPSS version 22
software. RESULTS: In total, 310 participants were included in this
study. The mean age of the participants was 26.1 years (SD = 5.2), while the
median age was 25 years (interquartile range = 22 - 29). Of the 310
participants included in the study, 128 developed a birth tract injury giving a
prevalence of 41.3% (95% CI, 35.8 - 47.0). The most common type of injury was
spontaneous tears (33.9%), the majority of which were perineal (30.6%) compared
to episiotomies (7.4%). Most perineal tears were first degree tears (23.2%) followed
by second-degree tears (6.8%). Third-degree perineal tears were rare (0.6%). We
did not have any cases of fourth-degree perineal tears. We also encountered a
few cases of cervical tears (0.6%). The factors associated with birth tract
injury were assessed using bivariate and multiple logistic regression analysis.
On bivariate analysis, being an adolescent parturient (OR = 2.8, 95% CI: 1.4 -
5.7, p = 0.005), single (OR = 1.78, 95% CI, 1.04 - 3.03, p = 0.034), having a
history of birth tract injury (OR = 1.69, 95% CI, 1.01 - 2.95, p = 0.042), a
duration of active phase of labour (OR = 2.1, 95% CI, 1.3 - 3.3, p = 0.002),
being a primipara (OR = 2.8, 95% CI, 1.0 - 8.4, p = 0.045), inducing labour (OR
= 2.4, 95% CI, 1.1 - 5.4, p = 0.033), augmenting labour (OR = 2.4, 95% CI, 1.1
- 5.4, p = 0.033), birthweight of 4000 g or more (OR = 3.0, 95% CI, 1.3 - 7.4, p cm (OR = 3.3, 95% CI, 1.5 - 7.9, p = 0.005) were
statistically significantly associated with birth tract injuries. The majority
of the blood loss post-partum was between 200 and 500 cc. Only one participant had a blood loss of 500 cc
and above. Also, the severity of genital pain lasting beyond 24 hours
postpartum was mostly less than 5/10 (50.6%) followed by genital pains >
7/10 (41.7%). The prevalence of infection of the injury was (1.6%) and no
maternal death from injury was recorded. CONCLUSION: The prevalence of
lower genital tract injuries in the Bamenda Regional hospital is high.
First-degree tears were the most common followed by episiotomies. The perineal
outcome in the BRH is poor and should be improved upon.