Perineal care – perineal repair (assessment of perineal trauma)

Bibliographic reference Study type Evidence level Number of women Women’s characteristics Intervention Comparison Length of follow-up Outcome measures Effect size Source of funding Additional comments
Andrews, Thakar, Sultan & Kettle, 2005. 426Before and after evaluation2+N=147 (Response rate 71%)Midwives (95%), junior doctors and students.Perineal repair coursePrior to attending course8 weeks after attending courseClassification or perineal trauma Reportred change in practice regarding rectal examination prior to and following perineal repairCorrect classification of tears: external anal sphincter (EAS) partially torn: 77% vs. 85%, p=0.049; EAS completely torn: 70% vs. 85%, p=0.001; internal anal sphincter (IAS) exposed but not torn: 63% vs. 82%, p<0.001; IAS torn: 45% vs. 67%, p<0.001; anal sphincter and mucosatorn: 80% vs. 89%, p=0.031. Respondents performing rectal examination prior to repairing perineal trauma after attending the course: 28% vs. 89%, p<0.001, McNemar’s test).
Significant shift in favour of a continuous suture to the perineal muscle and skin: continuous suture to muscle: 32% vs. 84%, p<0.001; continuous suture to skin 39% vs. 81%, p<0.001.
Not statedCountry: UK
Andrews, Sultan, Thakar & Jones, 2006. 427Prospective intervention study2+N=241 (esponse rate 95%)Nulliparous women with perineal trauma following childbirthReassessment of perineal trauma by research fellow following initial assessment by attending clinicianNo extra assessment7 weeks post-partumObstetric anal sphincter injuries (OASIS)The prevalence of OASIS increased significantly from 11% to 24.5% when women were re-examined by the research fellow.
Midwife diagnosis of OASIS n=8. 4 of these confirmed.
26 women who sustained OASIS were missed by the attending midwife.
Obstetricians identified 22 women (32%) with OASIS diagnosed, all confirmed.
A further 7 cases of OASIS were identified by the research fellow.
No midwife performed a rectal examination
No additional trauma identified at 7 week follow-up.
Not statedCountry: UK
Groom & Patterson- Brown, 2002. 428Propsective intervention study3N=121 intervention group

N=362 control group
Women who had sustained perineal trauma following childbirthReassessment of perineal trauma by research fellow following initial assessment by attending clinicianNo reassessmentNoneClassification of perineal trauma, with special interest in third and fourth degree trauma.Significantly more third degree tears identified in the assessed group: 14.9% vs 7.5%.

In the assessed group, only 11 of the 18 3rd degree tears were identified by the clinician attending the birth.

Percentages of women sustaining a third degree tear for each mode of birth: spontaneous vaginal birth: 3.2%; ventouse 14.9% and forceps 22%.

Comparing study data with findings for a similar group of women during the 6 months before and after the study period, the overall rates of third degree tears were: before: 2.5%; during: 9.3%; after: 4.6%
Not statedCountry: UK

From: Evidence tables

Cover of Intrapartum Care
Intrapartum Care: Care of Healthy Women and Their Babies During Childbirth.
NICE Clinical Guidelines, No. 55.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2007 Sep.
Copyright © 2007, National Collaborating Centre for Women’s and Children’s Health.

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