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The effect of implementing a new guideline and operative pro forma on the detection and management of third- and fourth-degree perineal tears

Authors Cornell K, De Souza A, Tacey M, Long D, Veerasingham M

Received 24 November 2015

Accepted for publication 11 February 2016

Published 5 May 2016 Volume 2016:8 Pages 131—135

DOI https://doi.org/10.2147/IJWH.S101188

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Fredrick Rosario Joseph

Peer reviewer comments 2

Editor who approved publication: Professor Elie Al-Chaer


Kristin Cornell,1 Alison De Souza,2 Mark Tacey,3 David M Long,4 Mayooran Veerasingham5

1Department of Obstetrics and Gynaecology, The Northern Hospital, Epping, VIC, 2Department of Urogynecology, Mercy Hospital for Women, Melbourne, VIC, 3Northern Clinical Research Centre, The Northern Hospital and Department of Medicine, University of Melbourne, Melbourne, VIC, 4Department of Emergency Medicine, The Austin Hospital, Melbourne, VIC, 5The Department of Obstetrics and Gynaecology, Ipswich General Hospital, Ipswich, QLD, Australia

Background: Obstetric anal sphincter injury (OASI) is a serious complication of vaginal births, resulting in possible long-term consequences such as incontinence and pain. Adequate detection and management of these injuries is vital in minimizing the impact they have on women.
Aim: To assess the rates of detection, management, and outcomes of OASI before and after the implementation of a new clinical practice guideline and operative pro forma.
Materials and methods:
A 12-month audit of the incidence, management, and outcomes of OASI was conducted in 2009. An operative pro forma and practice guideline were implemented in 2010 followed by a further audit undertaken between 2010 and 2012. Statistical analysis was performed to determine any significant change in practice.
Results: The distribution of risk factors for OASI including primiparity, birthweight, and type of vaginal delivery was similar between the two audited groups. After implementation of the pro forma, the reported incidence of OASI increased from 1.62% to 3.1% (P=0.004). Significant changes in management included an increase in the use of recommended suture material (48% vs 80%, P=0.002), postoperative antibiotics (78% vs 99%, P=0.001), postoperative catheterization (52% vs 90%, P<0.001), and inpatient physiotherapy consultations (44% vs 97%, P=<0.001). An increase was seen in women attending their 6-week follow-up appointment (33% vs 54% P=0.058); however, this was just below the level of statistical significance.
Conclusion: The introduction of the new pro forma and guideline resulted in an increase in the reported incidence of OASI, improved management, and follow-up of patients.

Keywords: perineal tear, obstetric anal sphincter injury (OASI), pro forma, guideline, anal incontinence, episiotomy

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