Management of 3rd and 4th Degree Perineal Tears after Vaginal Birth. German Guideline of the German Society of Gynecology and Obstetrics (AWMF Registry No. 015/079, October 2014)

Aigmueller, Thomas; Bader, W.; Beilecke, Kathrin; Elenskaia, Ksenia; Frudinger, Andrea; Hanzal, Engelbert; Helmer, Hanns; Huemer, Hansjoerg; Kleyn, Moenie van der; Koelle, David M.; Kropshofer, Stephan; Pfeiffer, James; Reisenauer, Christl; Tammaa, A; Tamussino, Karl; Umek, Wolfgang

doi:10.1055/s-0034-1396323

Cited by 15 publications

(16 citation statements)

References 83 publications

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“…This is understandable since the titles imply a variation in the content. Some are more general, looking at perineal injuries as a whole [ 15 , 16 , 19 , 9 ], and others are more focused on OASIs [ 8 , 10 – 14 , 17 , 18 , 20 ]. Whilst scope and content may vary, it is important that this is described in the outline of the guideline.…”

Section: Discussionmentioning

confidence: 99%

“…Search strategy was described by nine [8,9,11,13,14,[16][17][18]10]. The recommendations were based on research evidence in all of the guidelines, but the consensus method was only mentioned by one [12].…”

Section: Guideline Characteristics (Tables 1 and 2)mentioning

confidence: 99%

“…The quality assessment of the research evidence was described by seven, with one [13] using the AGREE II tool. The guideline development team members who reviewed or endorsed the recommendations and summary statements were not reported in four guidelines [12,16,18,19].…”

Section: Guideline Characteristics (Tables 1 and 2)mentioning

confidence: 99%

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Review of available national guidelines for obstetric anal sphincter injury

Roper

Amber²,

Wan

et al. 2020

Int Urogynecol J

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Introduction and hypothesis Obstetric anal sphincter injuries (OASIs) are the most severe form of perineal trauma with potentially devastating effects on a mother’s quality of life. There are various national guidelines available for their management. The aim of this study was to review and compare recommendations from published national guidelines regarding management and prevention of OASI. Methods We searched the PUBMED, EMBASE, MEDLINE, CINAHL and COCHRANE databases from January 2008 till October 2019 using relevant Medical Subject Headings (MeSH), including all subheadings. The guideline characteristics were mapped and methodological quality assessed with the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool by three independent reviewers. To compare the methodological quality of the guidelines, the interpretation of the six domain scores were taken into consideration. By consensus of the authors, a score of 70% was taken as a cut-off, and scores above this were considered ‘high quality’. Results Thirteen national guidelines on perineal trauma were included and analysed. Nine of these were specific to OASI. There is wide variation in methodological quality and evidence used for recommendations. AGREE scores for overall guideline assessment were > 70% in eight of the guidelines, with Australia-Queensland, Canada, the UK and USA scoring highest. Conclusions The wide variation in methodological quality and evidence used for recommendations suggests that there is a need for an agreed international guideline. This will enable healthcare practitioners to follow the same recommendations, with the most recent evidence, and provide evidence-based care to all women globally.

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Section: Discussionmentioning

confidence: 99%

Section: Guideline Characteristics (Tables 1 and 2)mentioning

confidence: 99%

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Review of available national guidelines for obstetric anal sphincter injury

Roper

Amber²,

Wan

et al. 2020

Int Urogynecol J

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“…Vaginal tears are generally repaired by a midwife immediately postpartum. When a sphincter lesion is suspected, the repair is conducted by a gynaecologist or a gastrointestinal (GI) surgeon in operating room conditions with proper anaesthesia [12].…”

Section: Introductionmentioning

confidence: 99%

Comparison of 3D endoanal ultrasound and external phased array magnetic resonance imaging in the diagnosis of obstetric anal sphincter injuries

et al. 2019

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Objectives The gold standard of postpartum anal sphincter imaging has been the 3D endoanal ultrasound (EAUS). Development of magnetic resonance imaging (MRI) has allowed anal sphincter evaluation without the use of endoanal coils. The aim of this study is to compare these two modalities in diagnosing residual sphincter lesions post obstetric anal sphincter injury (OASI). Methods Forty women were followed up after primary repair of OASI with both 3D EAUS and external phased array MRI. Details of the anal sphincter injury and sphincter musculature were gathered and analysed. Results There was a moderate interrater reliability ( κ = 0.510) between the two imaging modalities in detecting sphincter lesions, with more lesions detected by MRI. There was a moderate intraclass correlation (ICC) between the circumference of the tear ( κ = 0.506) and a fair ICC between the external anal sphincter thickness measurements at locations 3 and 9 on the proctologic clock face ( κ = 0.320) and ( κ = 0.336). Conclusions The results of our study indicate that the use of external phased array MRI is feasible for detecting obstetric anal sphincter lesions postpartum. This allows for imaging of the sphincter defects in centres where EAUS imaging is not available. Key Points • A two centre prospective study that showed external phased array MRI to be a valid imaging modality for diagnosing obstetric anal sphincter injuries. Electronic supplementary material The online version of this article (10.1007/s00330-019-06125-8) contains supplementary material, which is available to authorized users.

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“…One of the aims of obstetric care must therefore be to reduce the rates of high-grade perineal tears as much as possible. In the chapter on Epidemiology, the guideline of the German Society for Gynecology and Obstetrics (DGGG) on the management of 3rd and 4th degree tears after vaginal delivery [4] therefore lists the odds ratios for the different risk factors, the factors which reduce the risk and the extent to which obstetric measures can change the rate of high-grade perineal tears.…”

mentioning

confidence: 99%

Is the Outcome Indicator “3rd/4th Degree Perineal Tear in Spontaneous Singleton Births” a Reliable Quality Parameter in Obstetrics?

Franz

Erxleben

2015

Geburtshilfe Frauenheilkd

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Introduction !Injury to the anorectal sphincter complex during vaginal birth is a significant risk factor for anal incontinence in women. Between one and two thirds of women who sustained a third degree tear (classification based on [1] and [2]) detected immediately after delivery suffer from symptoms of anal incontinence [10].In women who present with persistent symptoms of incontinence postpartum or who go on to develop anal incontinence at a later stage after delivery, the incidence for a defect of the external anal sphincter (EAS) muscle is 90 % while the incidence for a defect of the internal anal sphincter (IAS) muscle is 65 % [3]. One of the aims of obstetric care must therefore be to reduce the rates of high-grade perineal tears as much as possible. In the chapter on Epidemiology, the guideline of the German Society for Gynecology and Obstetrics (DGGG) on the management of 3rd and 4th degree tears after vaginal delivery [4] therefore lists the odds ratios for the different risk factors, the factors which reduce the risk and the extent to which obstetric measures can change the rate of high-grade perineal tears. Assessment for Quality Assurance !The indicator set "3rd or 4th degree perineal tear" is used in Germany as a quality indicator for clinical area 16/1 (Obstetrics) [5]. The observed rate of 3rd and 4th degree perineal tears is calculated based on the number of documented 3rd and 4th degree perineal tears (numerator) in relation to all fully documented singleton births recorded in the Obstetrics score QI-ID 51181 (denominator). Since 2011, calculations have additionally included risk adjustment. The selected regression coefficients were risk factors recorded in the quality assurance documentation. Factors include maternal height, birth weight of the child, maternal age at delivery, and parity. Logistic regression analysis was used for risk adjustment. The reference range calculated for 2013 for this risk-adjusted indicator was ≤ 2.25. Abstract !Obstetric sphincter damage is the most common cause of fecal incontinence in women. Between one-third and two-thirds of women who sustain a recognized third-degree tear during delivery subsequently suffer from fecal incontinence. We should therefore try to reduce the rate of highgrade tears as much as possible. But this rate can only be used as an outcome indicator for the quality of obstetric departments if the recognition and classification of sphincter injury is similar across departments in different hospitals. Zusammenfassung

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Management of 3rd and 4th Degree Perineal Tears after Vaginal Birth. German Guideline of the German Society of Gynecology and Obstetrics (AWMF Registry No. 015/079, October 2014)

Abstract: The editorially complete, long version of these guidelines as well as a summary of the conflicts of interest of all the authors can be found on the homepage of AWMF: http://www.awmf.org/leitlinien/detail/II/015-079.html.

Cited by 15 publications

References 83 publications

Review of available national guidelines for obstetric anal sphincter injury

Review of available national guidelines for obstetric anal sphincter injury

Comparison of 3D endoanal ultrasound and external phased array magnetic resonance imaging in the diagnosis of obstetric anal sphincter injuries

Is the Outcome Indicator “3rd/4th Degree Perineal Tear in Spontaneous Singleton Births” a Reliable Quality Parameter in Obstetrics?

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