Incidence and Immediate and Early Complications of Severe Perineal Tears during Childbirth in a Reference Obstetric Care Institution in Medellin, Colombia/Incidencia, complicaciones inmediatas y tempranas de desgarros perineales graves durante el parto en una institución de referencia de atención obstétrica en 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 long-term morbidity that reguires proper diagnosis, management, and follow-up. Objective: To determine the incidence of SPTand 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 Medellin, 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 third-degree and 0.3%, of fourth-degree. Of these, 66.5% had instrument-assisted 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 infreguent. Postpartum follow-up strategies should be improved to identify and manage medium-term complications in a timely manner. Keywords Fecal Incontinence; obstetric Delivery/instrumentation; perineum/injuries; perineum/surgery. Introducción: los desgarros perineales graves (DPS) son complicaciones gue se presentan durante la atención del parto. Pueden desencadenar fístulas rectales e incontinencia fecal y urinaria, morbilidad a mediano y largo plazo gue reguiere diagnóstico, manejo y seguimiento adecuado. Objetivo: determinar la incidencia de DPS y complicaciones relacionadas inmediatas -primeras 48 horas- y tempranas -primeros tres meses- posteriores a la atención. Metodología: estudio de cohorte descriptiva de pacientes con DPS durante la atención obstétrica en un centro de referencia en Medellín, Colombia, entre 2015 y 2017. Se revisaron las historias y se registraron datos clínicos y complicaciones inmediatas y tempranas en la cita de control de piso pélvico. Resultados: se atendieron 14.24