Incidence and Determinants of Birth Canal Injuries Following Vaginal Delivery at Wad Madani Hospital, Sudan

Abstract

Background: The female perineum, forming the diamond - shaped inferior outlet of the pelvis, is highly susceptible to trauma during labour. Spontaneous perineal tears and iatrogenic episiotomies can lead to both immediate and long - term maternal morbidity. Objective: To determine the incidence, patterns, risk factors, and outcomes of birth canal injuries following vaginal deliveries at Wad Madani Obstetrics and Gynaecology Teaching Hospital between January and June 2024. Methods: We conducted a prospective, cross - sectional, hospital - based study. All women who sustained birth canal injuries during vaginal delivery at Wad Madani Teaching Hospital over the six - month period were enrolled. Data were collected via a structured questionnaire administered after informed consent. Injury types, maternal and obstetric characteristics, management details, and complications were recorded and analyzed. Results: Of 5, 237 vaginal deliveries, 102 women (1.9%) experienced birth canal injuries. Injury distribution was: cervical tears 38 (37.3%), perineal tears 31 (30.4%), vaginal tears 23 (22.5%), extended episiotomies 5 (4.9%), mixed lacerations 4 (3.9%), and de - circumcision injuries 1 (1%). More than half (52.9%) of injured women developed complications, including heavy bleeding 51 (94.4%), infection 12 (22.2%), vulvar hematoma 3 (5.6%), laparotomy 2 (3.7%), hysterectomy 2 (3.7%), disseminated intravascular coagulation 2 (3.7%), and rectovaginal fistula 1 (1.9%). The maternal mortality ratio was 57 per 100, 000 live births. Significant risk factors included instrumental delivery 10 (9.8%), assisted breech delivery 5 (4.9%), prolonged second stage of labour 20 (19.6%), home delivery under traditional birth attendant supervision 7 (6.9%), unattended home delivery 4 (3.9%), primigravity 51 (50%), and birth weight >4, 000 g 14 (13.7%). Only 25.9% of midwives and 51.2% of doctors had received formal training in birth canal injury management. Conclusion: The rate of birth canal injuries at this centre is substantial. There is a critical need to improve training for both doctors and midwives in the anticipation, prevention, and prompt recognition of perineal and cervical trauma during vaginal delivery.