Surgical repair and follow-up of chronic 4th degree obstetric perineal tear (total perineal defect) in 2 centres in eastern Africa.

INTRODUCTION AND HYPOTHESIS: Fourth-degree perineal tear occurs in up to 0.2% of vaginal deliveries. In limited resource communities, women often deliver in local villages without facilities to repair obstetric anal sphincter injuries. These fourth-degree tears heal by secondary intention and result in total perineal defects. The aim of the study is to present medium-term follow-up of a large number of women following repair of chronic fourth-degree tear. METHODS: Repairs of chronic obstetric fourth-degree tears were undertaken during surgical camps at Kagando Hospital, Uganda and Selian Hospital, Tanzania, from December 2013 to October 2019. Women completed Cleveland Clinic Incontinence Scores (CCIS) on admission (face to face) and during the 7-year follow-up period (via telephone). RESULTS: Two hundred fourteen women had medical history and CCIS completed on admission. The mean age at presentation was 33.9 years and mean duration of the condition was 8.9 years. Over a third of women stated they suffered social abandonment because of the unrepaired fourth-degree tear. Nearly 45% of women suffered the tear during the first vaginal delivery. At 1-year follow-up, 87% of 101 women scored 0 (perfect continence) and 94% of 66 women had perfect continence at 2 years. Forty-one births occurred during the follow-up period (32 vaginal deliveries) with two recurrences of fourth-degree tear. CONCLUSIONS: Follow-up in limited resource communities is challenging. Short- to medium-term results of women who had repair of total perineal defect (unrepaired fourth-degree obstetric tears) are encouraging.

Incidence of intimate partner violence among Ugandan women with pelvic floor dysfunction.

OBJECTIVE: To assess the occurrence of intimate partner violence (IPV) among women seeking surgery for pelvic floor dysfunction (PFD) in a rural African community. METHODS: A prospective questionnaire-based study was conducted among women with obstetric fistula, unrepaired obstetric anal sphincter injuries (OASIS), or severe (stage 3 or 4) pelvic organ prolapse (POP) who attended surgical camps at Kagando Hospital in western Uganda between July 15, 2016, and September 14, 2017. The control group comprised women without PFD. Participants completed the Hurt, Insult, Threaten, and Scream (HITS) tool and the Woman Abuse Screening Tool (WAST) to screen for IPV. RESULTS: 117 of the 312 women interviewed reported current IPV: 73/214 (34.1%) in the PFD group and 44/98 (44.9%) in the control group. The PFD group comprised unrepaired OASIS (n=85, 39.7%), obstetric fistula (n=75, 35.1%), and severe POP (n=54, 25.2%). All groups experienced high levels of IPV. The frequency of positive screening results for IPV with WAST (score ≥13.0) and/or HITS (score ≥10.5) were: severe POP (n=17, 31.5%), obstetric fistula (n=28, 37.3%), unrepaired OASIS (n=30, 35.3%), and control group (n=44, 44.9%). CONCLUSION: Women in western Uganda experienced high rates of IPV, regardless of whether or not they had PFD. ANZCTR number: ACTRN12617001073392.