Incidence and Immediate and Early Complications of Severe Perineal Tears during Childbirth in a Reference Obstetric Care Institution in Medellín, Colombia

Introduction: Severe perineal tears (SPT) are complications that arise during childbirth. These can result in rectal fistulas and fecal and urinary incontinence, leading to medium to longterm morbidity that requires proper diagnosis, management, and followup. Objective: To determine the incidence of SPT and related immediate complications (within the first 48 hours) and early complications (within the first three months) following delivery. Methodology: This article reports a descriptive cohort study on patients with SPT during obstetric care in a reference center in Medellín, Colombia, between 2015–2017. Medical records were reviewed, and clinical data and immediate and early complications were recorded during pelvic floor control appointments. Results: A total of 14,247 vaginal births were attended. The incidence of SPT was 1.6%, with 1.3% being of thirddegree and 0.3%, of fourthdegree. Of these, 66.5% had instrumentassisted vertex delivery, 81.9% had an episiotomy; the median expulsion period was 19 minutes, and 3% had shoulder dystocia. Immediate complications in patients with SPTs included: suture dehiscence and wound infection (0.85%), dehiscence (0.85%), and wound infection (0.42%). 18.4% attended the urogynecological control in the third month. Among them, 38.2% had at least one complication, mainly fecal and flatus incontinence (16.3% and 13.9%, respectively). Conclusions: The incidence of SPT and immediate postpartum complications were infrequent. Postpartum followup strategies should be improved to identify and manage mediumterm complications in a timely manner.