[Complete and complicated tears of the perineum in spite of preventive incision. A study of the risk factors and the short-term consequences].

A retrospective study of case controls was carried out by postal enquiry to find out the risk factors for complete complicated tears (DCC) of the perineum occurring after prophylactic episiotomy. There were 33 such cases of DCC out of 8,039 vaginal deliveries which means 0.41% in the University Centre in Grenoble in the years 1985-1986-1987. A control group of 66 cases was paired according to parity and episiotomy. The risk factors were identified as large fetal weight, instrumental deliveries, mid-line episiotomy or perineotomy. The questionnaires could be analysed for faults after delivery in 26 cases and 52 controls (response rate of 90%). The sole significant problem of the cases was perineal and rectal pain lasting more than a month longer than in the control cases. There was no greater dyspareunia, stress incontinence with urine, nor anal incontinence which contradicts previous reports in the literature. The authors conclude there are no serious complications of DCC following perineotomy providing repair is carried out very carefully. The patients in this group show that is was acceptable because no more in this group than in the controls were frightened of a repeat pregnancy.