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Objective To investigate the prevalence and risk factors of thirdand fourth-degree perineal lacerations in 24, mainly developing, countries.Design Analysis using cross-sectional data from the WHO Global Survey on Maternal and Perinatal Health.Setting Seven African, nine Asian and eight Latin American countries.Population Women at admission to hospital for delivery in 373 facilities between 2004 and 2008.Methods We estimated the country-wise prevalence of third-and fourth-degree perineal lacerations, and conducted region-wise multivariate logistic regression analyses to identify its risk factors.Main outcome measures Prevalence and risk factors of third-and fourth-degree perineal lacerations.Results A total of 214 599 women who underwent vaginal delivery were analysed. The prevalence of third-and fourth-degree perineal lacerations ranged widely across countries [from 0.1% (China, Cambodia, India) to 15.0% (Philippines)] and facilities (from null to 76.3%). After the deletion of facilities reporting no third-or fourth-degree perineal lacerations, and also highly outlying facilities, the range in prevalence was 0.1% (Uganda) to 1.4% (Japan). Forceps-assisted delivery, nulliparity and high birthweight were significant risk factors in all three regions. Vacuum-assisted delivery was also a significant risk factor in Africa and Asia.Conclusions Misdiagnosis of third-and fourth-degree perineal lacerations in developing countries may be common. Correct recognition and diagnosis may lead to timely treatment and fewer sequelae. Risk factors of third-and fourth-degree perineal lacerations in developing countries were similar to those previously reported from developed countries.Keywords Developing countries, multi-country study, third-and fourth-degree perineal lacerations.Please cite this paper as: Hirayama F, Koyanagi A, Mori R, Zhang J, Souza J, Gülmezoglu A. Prevalence and risk factors for third-and fourth-degree perineal lacerations during vaginal delivery: a multi-country study. BJOG 2012;119:340-347.

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The Japanese diet is high in soy products and fish. A case-control study was conducted in Japan to investigate the relationship between dietary intake of isoflavones and fatty acids and lung function, breathlessness and chronic obstructive pulmonary disease (COPD). A total of 278 referred patients aged 50-75 years with COPD diagnosed within the past 4 years, and 340 community-based controls were assessed for respiratory symptoms and undertook spirometric measurements of lung function. A validated food frequency questionnaire was administered face-to-face to obtain information on habitual food consumption. Dietary intakes of isoflavones and fatty acids were derived from the Japanese food composition tables. The COPD patients had significantly lower habitual intakes of isoflavones (genistein and daidzein) and polyunsaturated fatty acids (PUFA; both omega-3 and omega-6) than control subjects. Lung function measures were found to be positively associated with isoflavones and PUFA intake. Substantial reductions in prevalence of COPD and breathlessness were observed for isoflavones, the respective adjusted odds ratio being 0.36 (95% confidence interval 0.19-0.68) and 0.60 (95% confidence interval 0.33-1.10) for the highest versus lowest levels of total isoflavone intake. The corresponding tests for linear trend were significant. High intakes of PUFA and omega-6 fatty acids (derived from foods excluding oils and fats as seasonings) also appeared to reduce the risks of COPD and breathlessness symptom, but no evidence of association was found for other types of fatty acids. The study provided evidence of possible protective effect of traditional Japanese diet against tobacco carcinogens.

Increasing soy consumption was associated with a decreased risk of COPD and breathlessness.