A complete audit cycle of management of third/fourth degree perineal tears

Panigrahy, Rajashree; Welsh, James S.; Mackenzie, Fiona; Owen, Philip

doi:10.1080/01443610802054980

Cited by 12 publications

(8 citation statements)

References 9 publications

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“…31,55,57 In the last decade, specific training in the identification and repair of perineal tears has become established as an essential component of postgraduate training and continuing professional development for doctors and midwives. Studies in the UK that have evaluated the implementation of the documentation proforma and auditable standards recommended in the new guideline, 58,59 and in training interventions, 60 confirm that the increased awareness and appropriate examination have increased the likelihood of perineal tears being detected. 61 Another possible explanation is a gradual improvement in the coding of tears in the English HES database.…”

Section: Comparison With Previous Literaturementioning

confidence: 99%

Third‐ and fourth‐degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors

Gurol‐Urganci

Cromwell

Edozien

et al. 2013

BJOG

346

270

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Objective To describe the trends of severe perineal tears in England and to investigate to what extent the changes in related risk factors could explain the observed trends.Design A retrospective cohort study of singleton deliveries from a national administrative database.Setting The English National Health Service between 1 April 2000 and 31 March 2012.Population A cohort of 1 035 253 primiparous women who had a singleton, term, cephalic, vaginal birth.Methods Multivariable logistic regression was used to estimate the impact of financial year of birth (labelled by starting year), adjusting for major risk factors.Main outcome measure The rate of third-degree (anal sphincter is torn) or fourth-degree (anal sphincter as well as rectal mucosa are torn) perineal tears.Results The rate of reported third-or fourth-degree perineal tears tripled from 1.8 to 5.9% during the study period. The rate of episiotomy varied between 30 and 36%. An increasing proportion of ventouse deliveries (from 67.8 to 78.6%) and non-instrumental deliveries (from 15.1 to 19.1%) were assisted by an episiotomy. A higher risk of third-or fourth-degree perineal tears was associated with a maternal age above 25 years, instrumental delivery (forceps and ventouse), especially without episiotomy, Asian ethnicity, a more affluent socio-economic status, higher birthweight, and shoulder dystocia.Conclusions Changes in major risk factors are unlikely explanations for the observed increase in the rate of third-or fourth-degree tears. The improved recognition of tears following the implementation of a standardised classification of perineal tears is the most likely explanation.Keywords Episiotomy, instrumental delivery, severe perineal trauma, trends, vaginal delivery.

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Section: Comparison With Previous Literaturementioning

confidence: 99%

Third‐ and fourth‐degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors

Gurol‐Urganci

Cromwell

Edozien

et al. 2013

BJOG

346

270

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show abstract

“…Education and training may also help prevent errors (both failure of planning and in execution) and maintain the quality of care provided to patients 19–21 . Formal perineal tear repair courses for clinicians have been shown to improve various aspects of care, including an increase from 5% to 17% of patients receiving six‐week follow‐up 22 . The authors concluded that training helps raise awareness and ensure clinicians comply with clinical guidelines.…”

Section: Discussionmentioning

confidence: 99%

Perineal trauma management and follow‐up: Are we meeting the standard of care?

Peiris‐John

Park

Wells

et al. 2020

Aust NZ J Obst Gynaeco

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Background Birth‐related third‐ and fourth‐degree perineal trauma is common and associated with short‐ and long‐term complications. Aim To conduct a review of clinical audits investigating management of women with perineal trauma. Materials and Methods We identified all audits undertaken in eight New Zealand public hospitals between 2005 and 2014 that investigated whether women with birth‐related third‐ and fourth‐degree perineal trauma were receiving care according to clinical guidelines. We aggregated audit results and calculated the proportion of women receiving the recommended standard of care. Results During the review period, 25 audits investigated intra‐operative (n = 11), post‐operative (n = 14) and outpatient care (n = 18). Baseline audits showed variation in care by site; intra‐operative care (range 39–96% for repair conducted under anaesthesia, 60–96% for repair by or under supervision of a senior clinician, and 33–54% for completion of Accident Compensation Corporation forms); post‐operative care (range 40–93% for prescribed antibiotics and 33–96% for stool softeners) and outpatient care (45–84% for referral to outpatient clinic and 54–78% for physiotherapy follow‐up). Sustained high quality of care and improvements in adherence with recommendations were seen for most of the follow‐up audits (eg 90% adherence for prescribed stool softeners over three audits; over 50% increase in prescribed antibiotics over seven years). Conclusions These clinical audits exemplify the need to measure patient care against standards, learn from the findings, implement changes to improve patient experience and reduce life‐long sequelae from perineal trauma. This review showed some progress in some care services and highlighted where further changes are needed to close evidence‐practice gaps.

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“…The limited experience of healthcare personnel is also a risk factor of failure of primary repair [20]. A consultant was present in maternity hospitals in Glasgow in 58% of cases, but 95% of treatments were conducted by a physician who attended the relevant training course [21]. In the Czech Republic, obstetric injuries of Grades 3 and 4 were managed by an older consultant in 90.1% of cases in 2008 and in 92.7% of cases in 2016.…”

Section: Discussionmentioning

confidence: 99%

The impact of national guidelines on EBM implementation in clinical practice: a comparison between the practices in two countries

Záhumenský¹,

Pšenková²,

Janků³

et al. 2019

Clin. Exp. Obstet. Gynecol.

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To determine if the application of guidelines for obstetrical anal sphincter injuries (OASIS) management adopted by professional society in a country improves healthcare compared to a country where the guidelines are not adopted. Materials and Methods: In 2008 and 2016, a questionnaire was sent to every maternity ward in the Czech and Slovak Republics. In 2011, the guidelines for OASIS management were published in the Czech Republic. The authors compared the changes in the management of OASIS in both countries and evaluated the effect of the guidelines on healthcare improvement. Results: In 2008, the current Royal College of Obstetricians and Gynaecologists (RCOG) classification of OASIS was not used by any hospital in both countries. In 2016, the classification was used by 48.8% of hospitals in the Czech Republic and by 11.5% of hospitals in the Slovak Republic. The percentage of hospitals in the Czech Republic which used antibiotic prophylaxis while treating OASIS increased from 87.3% in 2008 to 100% in 2016. In the Slovak Republic, the percentage decreased from 85.7% to 73.1%. Active follow-up increased in the Czech Republic from 40% to 70.8%. In the Slovak Republic, it increased from 33.3% to 38.5%. In 2008, the management according to EBM was not performed by any of centres participating in the survey. In 2016, this percentage increased to 34.1% in the Czech Republic and to 3.8% in the Slovak Republic. Conclusion: The introduction of guidelines improved healthcare more significantly compared to the country where guidelines are not yet adopted.

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A complete audit cycle of management of third/fourth degree perineal tears

Cited by 12 publications

References 9 publications

Third‐ and fourth‐degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors

Third‐ and fourth‐degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors

Perineal trauma management and follow‐up: Are we meeting the standard of care?

The impact of national guidelines on EBM implementation in clinical practice: a comparison between the practices in two countries

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