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

Abstract

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.

Translation and Validation of the Birth Satisfaction Scale-Revised in Urdu for Use in Pakistan

“…The experience of childbirth has long been established to have a spectrum of potential impacts on the well-being of women, with potential negative impacts increasing clinical concern (Grandone et al, 2020;Harrison, Ayers, Quigley, Stein, & Alderdice, 2020;Peiris-John, Park, Wells, Kool, & Wise, 2020;Picetti et al, 2020;Watson, White, Hall, & Hewitt, 2020). Childbirth is a challenging experience physiologically and for some women psychologically (Affonso & Domino, 1984;De Schepper et al, 2016;Dekel, Ein-Dor, Dishy, & Mayopoulos, 2020;Orovou et al, 2020).…”

Welcome to ANZJOG 2021

“…In the following article, Peiris‐John et al . step up to the challenge, identifying all audits undertaken in eight New Zealand public hospitals during 2005–2014, to determine whether women diagnosed with third‐ or fourth‐degree perineal tears were receiving the care recommended in their relevant guidelines 7 . These authors found considerable variations in the type of anaesthesia provided, intraoperative techniques, post‐operative care, outpatient care and referral for physiotherapy.…”

“…In this issue of ANZJOG, Oh et al report on the experience, including training and frequency of exposure to cases, of colorectal surgeons across Australia and New Zealand 6. They find some important deficiencies in the management of OASI and recommend a multidisciplinary team involving both obstetricians and surgeons as the standard of care for these injuries.In the following article, Peiris-John et al step up to the challenge, identifying all audits undertaken in eight New Zealand public hospitals during 2005-2014, to determine whether women diagnosed with third-or fourth-degree perineal tears were receiving the care recommended in their relevant guidelines 7. These authors found considerable variations in the type of anaesthesia provided, intraoperative techniques, post-operative care, outpatient care and referral for physiotherapy.…”