Is it possible to predict or prevent third degree tears?

Byrd, L; Hobbiss, J; Tasker, M

doi:10.1111/j.1463-1318.2005.00801.x

Cited by 52 publications

(28 citation statements)

References 90 publications

(118 reference statements)

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“…A third‐degree perineal tear was defined as a perineal tear involving the skin/vaginal mucosa, underlying perineal muscles and the external/internal anal sphincter. A fourth‐degree perineal tear involved, in addition, tearing of the anal/rectal mucosa . Secondary outcomes were the difference between both groups regarding length of the episiotomy wound, suture and scar angles, long‐term episiotomy‐related pain and dyspareunia.…”

Section: Methodsmentioning

confidence: 99%

Comparison between two incision angles of mediolateral episiotomy in primiparous women: A randomized controlled trial

El-Din

Kamal

Amin

2014

J of Obstet and Gynaecol

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Section: Methodsmentioning

confidence: 99%

Comparison between two incision angles of mediolateral episiotomy in primiparous women: A randomized controlled trial

El-Din

Kamal

Amin

2014

J of Obstet and Gynaecol

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“…5 In the United Kingdom, of the 85% of women who sustain childbirth related perineal trauma (through either surgical episiotomy or spontaneous tear), 70% require suturing. 6 …”

Section: How Common Is It?mentioning

confidence: 99%

Managing perineal trauma after childbirth

Webb

Sherburn

Ismail

2014

BMJ

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specialist perineal midwife 1 , Margaret Sherburn women's health specialist physiotherapist 2 3 , Khaled M K Ismail professor of obstetrics and gynaecology 1 4 1 Birmingham Women's NHS Foundation Trust,Every year millions of women worldwide sustain trauma to the perineum when giving birth. Around 6% of these women will have short term wound complications such as infection and dehiscence. 1 Some are also at risk of long term problems such as dyspareunia, pain, urinary and faecal incontinence, pelvic organ prolapse, and psychosocial problems. Correct assessment and repair of this trauma is therefore essential to help reduce long term complications. In this review we focus on the management of childbirth related perineal trauma that does not involve injury to the anal sphincter complex (this has been dealt with previously 2 )-that is, first and second degree perineal trauma. We provide healthcare professionals caring for women during childbirth and the postnatal period with an overview of the current best evidence for the assessment, repair, and postnatal management of perineal trauma to reduce the incidence of complications in the short and long term.

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“…The overall rate of OASIS varies in reports (0.6-10.2%), [4][5][6][7][8] and is sometimes attributed to differences in definitions and clinical practices. 9 Perineal trauma is associated with considerable shortand long-term morbidity. The risk and severity of complications is proportional to the extent of the trauma.…”

Section: Introductionmentioning

confidence: 99%

Manual perineal support at the time of childbirth: a systematic review and meta‐analysis

Bulchandani

Watts

Sucharitha

et al. 2015

BJOG

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Background Genital tract trauma is common with vaginal births and is associated with significant morbidity, particularly with obstetric anal sphincter injuries (OASIS). Debate continues regarding the effectiveness of perineal support during childbirth in reducing the risk of trauma.Objectives This review aimed to assess the effect of routine 'hands on'/manual perineal support (MPS) during childbirth, versus ad hoc/no perineal support ('hands off/poised'), on the risk and degree of perineal trauma.Search strategy This review is registered on PROSPERO (http:// www.crd.york.ac.uk/PROSPERO/display_record.asp? ID=CRD42014007058). We searched the CENTRAL, Embase, Medline, CINAHL, and OVIDs midwifery and infant care databases (from inception to December 2014).Selection criteria Published randomised controlled trials (RCTs) and non-randomised studies (NRSs) evaluating any 'hands on' perineal support technique during childbirth.Data collection and analysis Two reviewers independently assessed trials for inclusion, data extraction, and methodological quality. Discrepancies were resolved by discussion with a third reviewer.Main results We included five RCTs and seven NRSs in the review. Meta-analysis of RCTs did not demonstrate a statistically significant protective effect of MPS on the risk of OASIS (three studies, 6647 women; relative risk, RR 1.03; 95% confidence interval, 95% CI 0.32-3.36; statistical test for heterogeneity I 2 = 71%). Meta-analysis of NRSs showed a significant reduction in the risk of OASIS with MPS (three studies, 74 744 women; RR 0.45; 95% CI 0.40-0.50; I 2 = 32%).Conclusion Current evidence is insufficient to drive change in practice. An adequately powered randomised trial with an efficient design to evaluate the complex interventions adopted as part of MPS policies, ensuring controlled childbirth, is urgently needed.Keywords Obstetric anal sphincter injuries, parturition, perineal support, perineal trauma. IntroductionIt is reported that 85% of women having a vaginal birth sustain some degree of perineal trauma. 1 Perineal tears are defined as first degree when the perineal skin is involved, second degree when the tear involves perineal muscles and skin, third degree when the anal sphincter complex is involved, and fourth degree when the tear involves all of the above structures and the anal epithelium or rectal mucosa. 2,3 Third-and fourth-degree tears are collectively called obstetric anal sphincter injuries (OASIS). The overall rate of OASIS varies in reports (0.6-10.2%), 4-8 and is sometimes attributed to differences in definitions and clinical practices. 9 Perineal trauma is associated with considerable shortand long-term morbidity. The risk and severity of complications is proportional to the extent of the trauma. 10,11 Despite identification and repair, postpartum complications such as perineal pain and faecal incontinence have a higher prevalence following OASIS, [12][13][14][15][16] and are associated with www.bjog.org Systematic review major psychological, physical, and social problems....

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Is it possible to predict or prevent third degree tears?

Abstract: Vaginal delivery will continue to be the main method of delivery and will continue to generate a low incidence of pelvic floor morbidity. The management of injury to the anal sphincter is facilitated by close co-operation between obstetricians and colorectal surgeons.

Cited by 52 publications

References 90 publications

Comparison between two incision angles of mediolateral episiotomy in primiparous women: A randomized controlled trial

Comparison between two incision angles of mediolateral episiotomy in primiparous women: A randomized controlled trial

Managing perineal trauma after childbirth

Manual perineal support at the time of childbirth: a systematic review and meta‐analysis

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