Prevalence and Associated Factors of Severe Perineal Tear at Mekelle Public Hospitals, Tigray, Northern Ethiopia: A Seven Years Review

<i>Background:</i> Obstetric anal sphincter injuries (OASIS) from perineal trauma during vaginal delivery are a significant cause of maternal morbidity, especially in low-resource settings. Despite skilled care in hospitals, such injuries still occur. This study investigates the prevalence and associated risk factors of third- and fourth-degree perineal tears at Mekelle Public Hospitals, Tigray, Northern Ethiopia, from July 2016 to June 2023. <i>Methodology:</i> A retrospective unmatched case-control study was conducted at Ayder Comprehensive Specialized Hospital and Mekelle General Hospital. All mothers with documented third- or fourth-degree perineal tears during vaginal delivery were included as cases, with three controls selected per case. Data from delivery logbooks and patient charts were extracted using a structured tool. Data were analyzed with EpiData Management version 4.6 and SPSS version 23, employing bivariate and multivariate logistic regression. Statistical significance was determined with a p-value of <0.05, and associations were measured using odds ratios. <i>Results:</i> A total of 361 women (88 cases, 273 controls) were included. The seven-year prevalence of severe perineal tears was 0.157% (1.57 per 1,000 vaginal deliveries). Significant risk factors included rural residence (AOR: 5.3, 95% CI: 2.1-13.3), primiparity (AOR: 4.7, 95% CI: 2.2-9.8), gestational age ≥ 40 weeks (AOR: 5.1, 95% CI: 2.5-10.3), birth weight ≥ 3.5 kg (AOR: 2.2, 95% CI: 1.1-4.5), and instrumental delivery (AOR: 5.1, 95% CI: 1.2-15.9). Mediolateral episiotomy was protective (AOR: 0.57, 95% CI: 0.3-0.9). <i>Conclusion:</i> Severe perineal tears are associated with identifiable maternal and delivery-related factors. Improved clinical vigilance, timely episiotomy, and skilled delivery practices are essential. Improved documentation and risk assessment strategies are recommended.