Perineal trauma in Africa: from normalized morbidity to preventable injury

Perineal trauma, comprising first and second-degree perineal tears and obstetric and anal sphincter injuries (OASIS), complicates a significant number of vaginal deliveries worldwide, and is documented as the second leading cause of postpartum hemorrhage, the leading killer of mothers in Sub-Saharan Africa (SSA). A recent review of low- and middle-income countries estimated rates of second-degree tears at 24% and OASIS at 1.4%.1 Yet these figures may underestimate the true burden of perineal trauma in SSA, where country-specific studies report OASIS rates as high as 7.4% in Ethiopia2 and 6.6% in Uganda.