Introduction. The frequency of performing episiotomy during delivery is decreasing due to lack of scientific justification for its use. Decreasing number of episiotomies has resulted in an increased percentage of spontaneous perineal tears. Aim of the study. Comparison of perineal tears in the period of eight years in two referral hospitals: primary and tertiary. Material and methods. The study analysed perineal tears in women after vaginal delivery. The study included 340 women from a primary referral hospital and 1766 women from a tertiary referral hospital admitted in 2005 and 2013. Results. In the primary referral hospital, episiotomy was performed in 2005 in 38% (143/374) women, and in 2013 in 44% (128/290). In the tertiary referral hospital, episiotomy was performed in 2005 in 66% (909/1366) women, and in 2013 in 39% (432/1089). In 2005, the percentage of perineal tears was significantly lower in the tertiary than in the primary referral hospital (12.92 vs 21.92%). In 2013, the percentage of perineal tears was significantly higher in the tertiary than in the primary referral hospital (41.98 vs 19.11%). Third and fourth degree perineal tears occurred more often during instrumental deliveries using forceps and when episiotomy was performed. Conclusions. Percentage of episiotomies is significantly higher than recommended by WHO. The number of all perineal tears is alarmingly high. The tendency to reduce the number of episiotomies and increasing number of perineal tears was found only in the tertiary referral hospital. It is recommended that clinical guidelines be developed in order to reduce the number of episiotomies.

Key words: episiotomy, perineal tear, childbirth, forceps.