Prevalence and Predictors of Severe Perineal Tears Following Episiotomy: A Cross-Sectional Study in Uganda

Abstract

Background: Episiotomy remains the primary surgical intervention during childbirth to prevent severe maternal complications, particularly in resource-constrained settings like Uganda, where alternatives are scarce. Despite WHO's recommendation to limit episiotomy rates to <10%, its use remains high, with risks of severe perineal tears. This study assessed prevalence and predictors of severe perineal tears following episiotomy: A cross-sectional study in Uganda. Methods: A hospital-based descriptive cross-sectional study enrolled 249 women who underwent episiotomy at MRRH from September-December 2024. Data were collected using structured questionnaires, and tears were confirmed via digital rectal examination. Data were analyzed at univariate, bivariate levels, followed by Modified Poisson regression to determine the factors associated with episiotomy extensions. Results: The mean maternal age was 22.9 (±4.2) years. Of 249 women, 34 (13.7%, 95% CI: 9.9-18.5%) experienced extensions, primarily third-degree tears (n = 31). Multivariate analysis identified two significant factors associated with episiotomy extension into third- or fourth-degree perineal tears: Fetal distress in the second stage of labour (aPR: 3.05 (1.66-5.60) p < 0.001) and delivery conducted by a medical intern doctor (aPR: 2.62 (1.10-6.21), p = 0.029). Conclusion: Approximately 1 in 8 women with episiotomy at MRRH sustained severe perineal tears and were associated with fetal distress and intern-assisted deliveries. To mitigate these outcomes, we recommend: enhanced mentorship and supervision for junior birth attendants and strict adherence to evidence-based practices to reduce procedural errors and we suggest reviewing the indications for episiotomy to lower the baseline rate. These measures could improve maternal safety and quality of care in similar low-resource settings.