Perinea Trauma during Childbirth: Socio Demographical Aspect and Management at Obstetrical Gynecology Department Donka National Hospital (Guinea-Conakry)

Perineal trauma is a non-surgical solution of continuity of posterior perineal committing under the effect of a violent exertion during childbirth. It occurs at the time of disengagement, either from the head or the posterior shoulder. Objectives: To calculate the perinea trauma during childbirth, describe the socio demographic profile of the women in childbed, identify contributory effects and appreciate the maternal prognostic. Methodology: It was a pros-pective study, descriptive type of 6 months (from May 19 to November 20, 2014). It took place at the maternity ward of Donka National Hospital. It concerned all received parturient, women in bed of a single fetus in the unit and having had a perineum traumatism. The real ones were epidemiologic, therapeutic clinical and prognostic. Results: We have recorded 110 perinea traumatism cases over 3496 childbirth let say a frequency of 3%. The socio demographic profile of the woman who did perinea traumatism was a teenager (42.7%), professional occupation (29.1%),


Introduction
The perinea trauma is a continuous solution non surgical of the posterious commeasure of the perineum under the effect of violent efforts during childbirth [1]. It occurs during the release, either the head or the posterious shoulder. Perinea trauma from obstetrical has always existed and continues to give real issues. These tears are due to young primipara and excised women, second-and third-degree [1] [2] [3]. The lesions can be serious in 6% of the cases, the concerned the external sphincter of the anus (third degree) or anal channel itself (fourth degree) and are sources of anal incontinence in 10% -47% of the cases [4]. Sometimes there are very invalidate leading to obstetrical fistula (urinary and digestives) and static pelvienne troubles [2] [5]. The frequency varies in accordance with the countries: in the USA 3% in 2008 [6], in France 5.7% in 2011 [7], in Tunis 15% of complete trauma and complicated in 2003 [2], in Congo 5.3% in 2005 [8], in Ivory Coast 10% in 2008 [9], in Guinea 11.1% in a hospital of level second (CMC Matam) after the monitoring findings of 2008. The objective was to calculate the perinea trauma frequency, determine the socio demographic profile of women in bed, identify factors favoring and appreciate maternal prognostic.

Methodology
This was a prospective, transversal study of 6-month (from May 19 to November 20, 2014). It concerned all the parturient received, delivered from a single fetus in the service and having had trauma of the perineum. The recruitment was exhaustive. The variables were socio demographic (age, occupation, marital status, level of Education, parity and pre-natal consultations, clinical (end of pregnancy, expulsion presentation, episiotomy, service providers, trauma type, factors favoring, fetal weight), therapeutic and prognostics.
The perineal tear of the first degree, said simple or incomplete, has been defined by cutaneous and muscular involvement, the sheath of the external sphincter of the anus remains intact ± superficial muscle of perineum (especially bulbocavernous muscle).
The perineal tear of second degree or completed was defined by a tear of the external sphincter, the internal sphincter remains intact.
Complicated third-degree tear or complicated perineum was defined by a complete tearing of the anal sphincter, tearing of the anal mucosa with opening of the anal canal.
The informed consent of patients has been obtained. We had obtained the prior approval of the national ethics committee. Open Journal of Obstetrics and Gynecology During the realization of this work we encountered some difficulties to know: -the occurrence of the Ebola virus disease with the psychosis that reigned in Donka has decreased the number of women giving birth in Donka; -the disrespect of the appointments for the control with the sixth and the forty second of the post partum.

1) Frequency:
The frequency found in our series is identical to that reported by American Authors [6], but inferior to other literature data [7] [8] [9]. This high frequency in the unit could be related in one hand to its position in the health pyramid of Guinea (level 3) and on the other hand, the majority were teenagers in this sampling.

2) Socio Demographic Characteristics:
Teenager could be a factor of predisposition of the perineum trauma.  [10]. The parity could favorise the occurrence of perinea trauma.
In our sampling all groups were touched with the highest proportion for the first childbirth (70%). These findings look like to others of many African authors [9] [11] [12]. This high frequency of trauma with primipare could be explained by the fact that molecular beams and attached are intact and solid with patients in one hand and on the other hand the reticent of some service providers to practice preventive episiotomy.

3) Clinical Variables:
In our series, 94.5% of the parturient was at the end contrary to Gandzien P.C.et Col [10] in Congo in 2005 where predominated going beyond term (75%). this high rate of fetal factors could be in relation with the fetal microsomy in the occurrence of perinea trauma. However, whatever the factor causing the traumatism, the service provider is very often hold responsible. All birth weight favorise perinea trauma. In our series the weight between 2500 to 3999 g dominated (70%) followed by the 4000 g and more (27, 3%). Weight inferior to 2500 g worth care because they are sometimes generators of these lesions.

4) Treatment:
All the perinea lesions were immediately sutured after the childbirth.
Infection had dominated the followed up layers in our study population with 8%. The remarks were the same in the African literature [2] [10]. The hygiene insuffisance could be an explanation.

Conclusions
Perinea trauma was frequent in our study. It was favorised by prim parity, young age, and instrumental extraction by forceps. The management was surgical (100%). The follow up was simple in 88.2% of the cases versus to 11.8% of the complications.
The reduction of this frequency requested systematical practice and corrected encountered prenatal consultations and the respect of episiotomy indications.