Delivering a Birth Safely – Case Reports of Perineal Infection Prevention among Pregnant Women Living Around Ex-landfills

Abstract

Abstract Background: Pregnant women living around ex-landfills have a higher risk of infection due to slum milieu, poor nutritional status, and fetal head pressure on the perineum during labor which can cause it to tear. Objective: This research aimed to emphasize the importance of limiting prophylaxis antibiotics for the 1st and 2nd degrees of perineal tears due to their negligible risk of infection. Case presentations: This is a report of two primigravid women aged 19 years old (cases 1 and 2) and multiparous women aged 29 and 30 yo (cases 3 and 4) who managed to give birth safely in Puskesmas (Indonesian primary healthcare facilities), despite having low blood pressure and non-adherence to antenatal care. All of them suffered from 2 nd degree of perineal tears and received analgesics, iron, vitamin B complex, and vitamin A tablets. The subjects attended puerperium care on days, 14, and 42 postpartum at Puskesmas. Discussion: In March 2020, Puskesmas' healthcare team performed a new 1st and 2nd-degree perineal tears prevention without antibiotics following normal vaginal birth. Standard care consists of personal hygiene, perineal wound care, and education on the importance of nutritious food and adherence to maternal supplementation. All subjects presented with complete perineal wound healing without infection at day-42 postpartum. Conclusion: It can be concluded that 2nd -degree perineal tears infection following normal vaginal birth could be prevented without antibiotics. It is strongly suggested to control the maternal nutritional states, potentially interfering with the maternal ability to heal the perineal wound. Keywords: perineal wound, infection risk, prevention, antibiotics, covid-19