Incidence and Immediate and Early Complications of Severe Perineal Tears during Childbirth in a Reference Obstetric Care Institution in Medellín, Colombia

Abstract

Introduction: Severe perineal tears (SPT) are complications that arise during childbirth. These can result in rectal fistulas and fecal and urinary incontinence, leading to medium- to long-term morbidity that requires proper diagnosis, management, and follow-up. Objective: To determine the incidence of SPT and related immediate complications (within the first 48 hours) and early complications (within the first three months) following delivery. Methodology: This article reports a descriptive cohort study on patients with SPT during obstetric care in a reference center in Medellín, Colombia, between 2015–2017. Medical records were reviewed, and clinical data and immediate and early complications were recorded during pelvic floor control appointments. Results: A total of 14,247 vaginal births were attended. The incidence of SPT was 1.6%, with 1.3% being of third-degree and 0.3%, of fourth-degree. Of these, 66.5% had instrument-assisted vertex delivery, 81.9% had an episiotomy; the median expulsion period was 19 minutes, and 3% had shoulder dystocia. Immediate complications in patients with SPTs included: suture dehiscence and wound infection (0.85%), dehiscence (0.85%), and wound infection (0.42%). 18.4% attended the urogynecological control in the third month. Among them, 38.2% had at least one complication, mainly fecal and flatus incontinence (16.3% and 13.9%, respectively). Conclusions: The incidence of SPT and immediate postpartum complications were infrequent. Postpartum follow-up strategies should be improved to identify and manage medium-term complications in a timely manner.

Keywords

• fecal incontinence
• obstetric delivery/instrumentation
• perineum/injuries
• perineum/surgery