FREQUENCY OF PERINEAL TEARS IN PRIMIGRAVIDA DELIVERED WITHOUT EPISIOTOMY AT A TERTIARY CARE HOSPITAL

Objective: To establish the frequency of perineal tears (3^rd and 4^th degree) in primigravidas delivered without episiotomy at a tertiary care hospital. Setting: Department of Obstetrics and Gynecology at Lady Willingdon Hospital, Lahore. Duration of Study: Six month from June 2020 to December 2020.  

Study Design: Randomized control trial. Subject and Methods: 200 primigravida women with singleton pregnancy and cephalic presentation and no other comorbidities were included in the study. The subjects were observed in labor room till the second stage of labour. Two equal groups (A and B) of 100 each subjects were assigned. In Groups-A, right mediolateral episiotomy was performed under local anesthesia at the time of crowing. In Group B no episiotomy incision was given. After deliver, the subjects were looked for any extension of episiotomy in Group A and 3^rd and 4^th degree perineal tear in both groups. Results:  Mean age was 26.73±4.27 years in group A and 26.54±4.46 years in group B (p=0.624). Mean gestational age was 37.27±1.73 weeks was in group A and 37.11±1.89 weeks in group B (p=0.646). The rate of 3^rd and 4^th degree perineal tear was significantly higher in group A as compare to group B [62% vs. 46% p=0.022] and [58% vs. 38% p=0.017] respectively.  Conclusion: Episiotomy incision was found to be an important trigger for the occurrence and extension of the perineal tear. Therefore it should always be performed only where it is inevitable and highly indicated like rigid perineum, forceps assisted delivery, obstructed labor and shoulder dystocia.

Keywords: Perineal tear; episiotomy; primigravida; labor; spontaneous vaginal delivery.