Incidence of Perineal Tear According to Sultan's Classification in a Tertiary Care Centre of Central India: An Observational Prospective Study

Abstract

Aims: To determine the incidence of perineal tear and to classify cases according to Sultans classification in a tertiary care centre of central India and to identify associated risk factors.

Settings and Design: Prospective, observational study

Methods and Material: This study took place in department of OBGY, MYH Hospital, Indore for a period of 1 year which includes all vaginally delivered females who underwent some degree of perineal tear either in our institution or referred from outside. Non obstetrical perineal trauma were excluded. Cases were classified according to Sultans classification. Predisposing factors were assessed using a questionnaire.

Statistical analysis used: Fisher’s Exact test, Pearson Chi-square test

Results: Out of total 4712 deliveries in a year, 230 females with perineal tear were identified. Incidence being 4.9% & classified as 1^st degree-80(34.8%), 2^nd degree-144(62.6%), 3a 2(0.9%), 3b 1(0.4%)  4^th degree-3(1.3%) according to Sultans classification. Pre-disposing high risk factors identified were nulliparity, postdated pregnancy, malpresentations, delivered outside in primary or secondary care hospitals and labour induction where Postdated  (p=0.001), nulliparity(p=0.001) and malpresentation (p=0.001) were significant whereas Episiotomy was identified as protective factor.

Conclusions: Identification of risk factors, vigilant monitoring, supervision and perineal support are the key factors for prevention of perineal tear. Reducing the incidence and prevention of its complications can help minimizing major cause of postnatal morbidity in females

Key-words: Perineal Tear; Sultans Classification; Incidence; Postdated pregnancy; Nulliparity;  Malpresentations

Key Messages: Through this study, we will be able to identify the root cause and high risk factors associated which helps in minimising its incidence. Proper counselling and prevention is the key to decrease the pain and sufferings so that the women feels safe and supported when undergoing repair and postpartum management after severe perineal trauma