title: Prevalence and risk factors for third- and fourth-degree perineal lacerations during vaginal delivery: a multi-country study.
abstract: OBJECTIVE
  To investigate the prevalence and risk factors of third- and fourth-degree perineal lacerations in 24, mainly developing, countries.
  
  
  METHODS
  Analysis using cross-sectional data from the WHO Global Survey on Maternal and Perinatal Health.
  
  
  METHODS
  Seven African, nine Asian and eight Latin American countries.
  
  
  METHODS
  Women at admission to hospital for delivery in 373 facilities between 2004 and 2008.
  
  
  METHODS
  We estimated the country-wise prevalence of third- and fourth-degree perineal lacerations, and conducted region-wise multivariate logistic regression analyses to identify its risk factors.
  
  
  METHODS
  Prevalence and risk factors of third- and fourth-degree perineal lacerations.
  
  
  RESULTS
  A total of 214,599 women who underwent vaginal delivery were analysed. The prevalence of third- and fourth-degree perineal lacerations ranged widely across countries [from 0.1% (China, Cambodia, India) to 15.0% (Philippines)] and facilities (from null to 76.3%). After the deletion of facilities reporting no third- or fourth-degree perineal lacerations, and also highly outlying facilities, the range in prevalence was 0.1% (Uganda) to 1.4% (Japan). Forceps-assisted delivery, nulliparity and high birthweight were significant risk factors in all three regions. Vacuum-assisted delivery was also a significant risk factor in Africa and Asia.
  
  
  CONCLUSIONS
  Misdiagnosis of third- and fourth-degree perineal lacerations in developing countries may be common. Correct recognition and diagnosis may lead to timely treatment and fewer sequelae. Risk factors of third- and fourth-degree perineal lacerations in developing countries were similar to those previously reported from developed countries.
authors.affiliation: Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: F
authors.initials: F
authors.lastname: Hirayama
authors.forename: A
authors.initials: A
authors.lastname: Koyanagi
authors.forename: R
authors.initials: R
authors.lastname: Mori
authors.forename: J
authors.initials: J
authors.lastname: Zhang
authors.forename: J P
authors.initials: JP
authors.lastname: Souza
authors.forename: A M
authors.initials: AM
authors.lastname: Gülmezoglu
mesh_terms: D000328:Adult; D000349:Africa / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D001724:Birth Weight; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005113:Extraction, Obstetrical / Q000009:adverse effects; D005260:Female; D006801:Humans; D022125:Lacerations / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D007843:Latin America / Q000453:epidemiology; D016015:Logistic Models; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D010298:Parity; D036801:Parturition; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors