Complications After Childbirth-Related Perineal Trauma up to Six-Weeks Postpartum: A Prospective Cohort Study.

OBJECTIVE: To determine the prevalence of perineal wound infection after childbirth-related perineal trauma up to 6 weeks postpartum. DESIGN: Prospective, multi-centre cohort study. SETTING: Fifty-one UK NHS maternity services. POPULATION: There were 2021 women who consented to take part and 1213 women who completed their 6-week questionnaire. METHODS: All women aged 16 or over who sustained childbirth-related perineal trauma of any type after spontaneous or assisted vaginal birth were eligible. Medical record review and distribution of questionnaires took place at 6 weeks postpartum. MAIN OUTCOME MEASURES: The primary outcome was perineal wound infection within 6 weeks postpartum, determined using medical record data and questionnaire response. RESULTS: Six-week medical record check data was available for 1998 women (99%). 1213 (60%) of women completed their 6-week questionnaire. 70.6% of consented women experienced a spontaneous vaginal birth and 29.4% of women an assisted vaginal birth. Across all types of perineal trauma and all modes of birth, the overall rate of perineal wound infection was 5.5% (95% CI 4.6%-6.6%). When considering the rate of wound infection by type of tear, women with episiotomy had the highest rate of wound infection at 9.5% (95% CI 7.5%-11.9%). CONCLUSION: We provide the best estimate to date of perineal wound infection after childbirth-related perineal trauma. Improvements to care to reduce perineal wound infection rates are urgently needed, particularly for groups where currently there are no targeted interventions postnatally, such as women who undergo episiotomy after spontaneous vaginal birth.