We included all women who gave birth vaginally at the maternity ward of the Ratoma Communal Medical Center and whose delivery was complicated by a perineal tear and who gave their informed consent.

Women received immediately postpartum with perineal tear were excluded from the study.

A previously established survey sheet served as an instrument for data collection. Incidentally, we consulted the CPN notebooks and the reference and evacuation sheets.

The data were processed using Word, Excel, PowerPoint and Epi info version 2000 software. Presented in the form of figures, tables and texts with comments and comparisons according to current literature data.

The comparison between the different variables was made using the Pearson chi-square test and the observed differences were considered significant when p ≤ 5%.

We were unable to highlight occult lesions of the anal sphincter.

We obtained the agreement of the administrative authorities of the university and the agreement of the head of the gynecology-obstetrics department for the collection of data, as well as the verbal informed consent of the parturient or responsible parents. Confidentiality was respected.

During our study period, we recorded 136 cases of perineal tear out of the 1510 deliveries carried out, i.e., a frequency of 9%.

Age: Women in the 15 - 20 and 21 - 26 age groups were the most affected with 30.15% and 41.18% respectively. The average age of the patients was 23.99 years ± 5.18 years, with extremes of 15 and 38 years.

Profession: housewives were the most numerous and represented 30.88%.

Marital status: married parturient represented 90% in this series.

Origin: most of the parturient came from the commune of Ratoma, i.e., 72.79%.

Level of education: those not in school and those in secondary education represented 33.09% and 38.24%, respectively.

Parity: pauciparous and nulliparous were the most affected with 47.79% and 40.44% respectively.

Number of prenatal consultations: most pregnant women had benefited from between 1 and 3 prenatal consultations, i.e., 55.88%, 4 and more (40.46%), and 3.68% had not benefited from any number of prenatal consultations.

Mode of admission: compared to the mode of admission, 93% were evacuees ( Table 1 and Table 2 ).

In relation to the nature of the perineal scar, scars caused by excision were the most numerous (99.26%), followed by those caused by episiotomy (22.79%) and the tear perineal (13.97%) ( Table 3 ).

Concerning the types of presentation, cephalic was found in 96.32% of the cases, complete breech was found in 2.21%, and incomplete breech was found in 1.47%.

As for the variety of presentation position, it was occipito-iliac left anterior (OIGA) in 37.40%, occipito-iliac anterior right in 12.21%, occipito-iliac posterior right in 3.81% and it was indeterminate in 46.56 % of cases. The expulsion was occipito pubis in 88.97% and occipito sacral in 11.03%.

The duration of the expulsion was less than 45 minutes in 41.18%, greater than 45 minutes in 24.26% and less than 45 minutes in 41.18% and this duration was indeterminate in 34.56%. The expulsion was spontaneous in 96.32% and instrumental by ventouse in 3.68%.

Abdominal expression: although this practice is prohibited, 17 women still underwent it, i.e., most deliveries were carried out by a midwife (93%).

Episiotomy was performed in 23.53%. It was in all cases of the medio-lateral type.

Classification: the perineal tear was type 1 in more than half of the cases (54.41%), type 2 (39.71%), type 3 (5.15%) and type 4 (0.73%).

Management was provided by suturing the lesions in most cases (87.6%).

Associated risk factors ( Tables 4-14 ).

The frequency of perineal tear is high in this series (9%). It is three times higher than that reported at the maternity ward of the Donka National Hospital of the Donka University Hospital, which was 3 [5] . This high frequency could be explained by the fact that the CMC Ratoma maternity ward is a level II structure of the health pyramid intended to receive parturient from peripheral health centers and childbirth houses in the most populated commune of Conakry after that of Matoto. Fouejio et al. in Cameroon reported a higher rate of 12.97% [8] . In Nigeria, Ojule et al. found an incidence of 13.7% of spontaneous tears [9] . A lower frequency is reported in France (1.79%).

The average age of parturient was 23.99 years, with the extremes of 15 and 38 years. This result could be explained by the precocity of marriage in our environment. Fouedjio et al. in Cameroon reported an average age of 24.94 years ± 4.55 years with extremes of 15 and 39 years [8] .

Chehab et al. in France in 2014 reported an average age of 30.7 years [10] .

In this study, housewives were the most concerned, followed by pupils/students.

Fouelifak F.Y. et al. in Cameroon in 2016 met more pupils/students followed by housewives with the proportions of 40.6% and 24.1%, respectively. [8]

The predominance of housewives reflects the structure of our society where these women are the most numerous, the majority of who are illiterate with a low income to cover health costs.

The high frequency of married women could be explained by 2 reasons:

Factors associated with the occurrence of perineal tear:

Maternal age was not a factor associated with the occurrence of perineal tears in this series.

Regarding the mode of admission, the risk of occurrence of perineal tear was associated with obstetric evacuation. This could be explained by the condition of the perineum of the evacuees, often edematous and infected by the perineal trauma caused by untimely vaginal examinations in patients whose labor is prolonged. This situation explains the fragility of the perineum of the evacuees.

Almost all women in our study had undergone female genital mutilation; type 2 was the most frequently encountered. Female genital mutilation is still relevant today; it is a practice strongly anchored in the social structures of the country, customs and traditions. These factors limit the effectiveness of measures to combat these practices despite their ban.

Millogo-Traoré F. et al. in Burkina Faso, in a study on maternal and fetal prognosis during childbirth in excised women, found an FGM prevalence of 72.86% and distributed the different types of FGM according to the WHO classification: type I (27.75%), type II (69.61%); type III (2.64%) [12] .

As for parity, the majority were pauciparous 47.79%, followed by primiparous 40.44%.

Barbier A. in France, in a study on the risk factors for lesions of the anal sphincter during childbirth in 2007, found 71% of primiparous women. [13]

Fouejio et al. in Cameroon in 2015 reported respectively 73.4% primiparous, 24% pauciparous and 2.6% multiparous [8] .

Parity appears in this study as a risk factor associated with the occurrence of perineal tear (p = 0.00). Primiparity was a recognized risk factor for obstetric lesions, as evidenced by the study by Barbier A. et al. (71 versus 43%, p = 0.001) [13] .

Regarding the perineal state, our results concerning the scarred perineum (p = 0.48) are contrary to other studies, Fouedjio et al. in their study found that the history of perineal tear multiplies by 14 the risk of tear [8] .

Edematous perineum was associated with perineal tear (p = 0.0003).

A systematic cesarean section was performed in all our patients who presented risk factors for dystocia. A large retrospective study reported an association between shoulder dystocia and the occurrence of 3rd and 4th degree tears. In 2015, the CNGOF established Recommendations for Clinical Practice concerning shoulder dystocia, which state that the risk of severe perineal lesions is increased after shoulder dystocia following the maneuvers performed [14] [15] .

The use of suction cups, although recognized as a risk factor in the literature, is not significant in our study (p = 0.95), this could be explained by a very small sample of cases of suction cup use.

Kudish in the USA in 2008 found a significant link between the use of suction cups and the occurrence of 3rd and 4th degree tears (OR 2.9 CI 1.9 - 4.4). The CNGOF established that the use of suction cups, compared to forceps, was less harmful to the perineum [16] [17] .

We also find a link between abdominal expression and the occurrence of tearing of the perineum (p = 0.01). In fact, the violent expulsion that it causes promotes tear perineal.

The performance of the episiotomy was not associated with the occurrence of perineal tear.

Barbier A. et al. reported that performing an episiotomy had no impact on the occurrence of a perineal tear (p-value = 0.10) [13] .

The weight of the newborn does not appear to be a risk factor associated with the occurrence of perineal tears in our study. This result is different from those of Smith et al. in England and Nkwabong et al. as well as Mikolajczyk et al. who found that higher birth weight was associated with an increased risk of perineal tear [18] - [20] .

A high head circumference (more than 36 cm) was associated with a risk of perineal tear due to over-distension of the perineum. Fouedjio et al. also found a very significant link between a head circumference greater than 36cm and the occurrence of perineal tears (p-value = 0.0000) [8] .