Abstract: Introduction: This study seeks to elucidate the maternal and fetal factors that predispose women to varying degrees of perineal tear during vaginal delivery with episiotomy. By identifying these predictors, the research aims to inform strategies to reduce the risk of complications associated with perineal and vaginal lacerations, thereby minimizing the maternal morbidity and optimizing obstetric outcomes.
Aims and Objectives: This study aims to determine the factors linked to episiotomy wound extension after vaginal delivery, in order to better understand the underlying causes and develop effective prevention strategies.
Methodology: A prospective observational study was conducted at the Department of Obstetrics and Gynecology, Midnapore Medical College and Hospital, from August 1, 2023, to October 31, 2023. The study enrolled 180 women who underwent vaginal delivery with episiotomy, meeting the specified eligibility criteria. A comprehensive data collection tool was utilized to gather sociodemographic, maternal, fetal, and intrapartum risk factors. The collected data was analyzed using descriptive statistics and presented in a structured format.
Results: Among the maternal risk factors, both mild and severe degree of perineal tear were more significantly seen in the age groups of 20-30 years (p-value-0.004). Severe perineal trauma also most commonly seen in primipara women (85.18%, p-value-0.01). There was also significant association of extension of episiotomy wound with overweight (p value-0.004) and pregnancy interval less than 2 years (p value-0.00001). There was significant association of severe degree of perineal injury with increase fetal birth weight (92.59%, p value-0.01), fetal head circumference (81.48%, p-value-0.00001) and persistent occipito-posterior position of fetal head (74.07%, p value-0.00001). Prolonged duration of active 1st stage of labor (81.48%, p value-0.000027) and induced labor (77.77%, p value-0.00001) are significantly more prone to severe degree of perineal tear.
Conclusion: Mothers who experience vaginal delivery with episiotomy are at risk of perineal tears, particularly those in extreme age groups, primiparas, overweight mothers, those with short pregnancy intervals, increased fetal birth weight, persistent occipito-posterior fetal head position, prolonged active first-stage labor, and induced labor. To mitigate this risk, careful attention should be given to mothers with these factors. A well-planned and executed episiotomy, appropriate procedure and guarding of perineum can help in prevention of severe perineal trauma, although certain maternal, fetal, and intrapartum factors may still contribute to the extension of the episiotomy wound from mild to severe.
Indexed in Index Copernicus
