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DOI: 10.1055/s-0035-1545703
Is the Outcome Indicator “3rd/4th Degree Perineal Tear in Spontaneous Singleton Births” a Reliable Quality Parameter in Obstetrics?
Ist der Ergebnisindikator „Dammriss Grad III/IV bei spontanen Einlingsgeburten“ ein zuverlässiger geburtshilflicher Qualitätsparameter?Publication History
Publication Date:
16 March 2015 (online)
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 high-grade 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
Eine Verletzung des analen Sphinkters stellt einen wesentlichen Risikofaktor für die Entwicklung einer analen Inkontinenz bei Frauen dar. Ein bis zwei Drittel der Frauen, bei denen unmittelbar nach der Entbindung ein Dammriss (DR) Grad III festgestellt wird, leiden an analen Inkontinenzsymptomen. Eine möglichst niedrige Rate höhergradiger Dammrisse ist deshalb anzustreben. Diese Rate ist als Ergebnisindikator zur Beschreibung der Qualität einer geburtshilflichen Abteilung aber nur dann verwendbar, wenn eine vergleichbare Qualität der Wahrnehmung und Klassifizierung von analen Sphinkterverletzung in den Abteilungen besteht.
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References
- 1 Cunningham FG, Leveno K, Bloom S. Williams Obstetrics. 23rd. ed. New York: McGraw-Hill Professional; 2010
- 2 Sultan AH, Thakar R, Fenner DE eds. Perineal and anal Sphincter Trauma. London: Springer; 2007
- 3 Nichols CM, Nam M, Ramakrishnan V et al. Anal sphincter defects and bowl symptoms in women with and without recognized anal sphincter trauma. Am J Obstet Gynecol 2006; 194: 1450-1454
- 4 Aigmueller T, Bader W, Beilecke K et al. 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). Geburtsh Frauenheilk 2015; 7: 137-144
- 5 Aqua-Institut GmbH. Qualitätsindikatoren Modul 16/1 – Geburtshilfe. Göttingen: Eigenverlag; 2013
- 6 Groom KM, Paterson-Brown S. Can we improve on the diagnosis of third degree tears?. Eur J Obstet Gynaecol Reprod Biol 2002; 101: 19-21
- 7 Andrews V, Sultan AH, Thakar R et al. Occult anal sphincter injuries – myth or reality?. BJOG 2006; 113: 195-200
- 8 Fernando RJ, Sultan AH, Radley S et al. Management of obstetric anal sphincter injury: a systematic review and national practice survey. BMC Health Serv Res 2002; 2: 9
- 9 Sultan AH, Kamm MA, Hudson CN. Anal sphincter function after delivery. N Engl J Med 1993; 329: 1905-1911
- 10 Dudding TC, Vaizey CJ, Kamm MA. Obstetric anal sphincter injury: incidence, risk factors, and management. Ann Surg 2008; 247: 224-237
- 11 Williams AB, Bartram CI, Halligan S et al. Anal sphincter damage after vaginal delivery using three-dimensional endosonography. Obstet Gynecol 2001; 97: 770-775
- 12 Williams A, Tincello DG, White S et al. Risk scoring system for prediction of obstetric sphincter injury. BJOG 2005; 112: 1066-1069
- 13 Gudmundsson S, Henningsson AC, Lindquist P. Correlation of birth injury with maternal height and birthweight. BJOG 2005; 112: 764-767
- 14 Eason E, Labrecque M, Wells G et al. Preventing perineal trauma during childbirth: a systematic review. Obstet Gynecol 2000; 95: 464-471
- 15 Cheng YW, Hopkins LM, Caughey AB. How long is too long: does a prolonged second stage of labor in nulliparous women affect maternal and neonatal outcomes?. Am J Obstet Gynecol 2004; 192: 1702-1706
- 16 Laine K, Skjedestad FE, Sandvik L. Incidence of obstetric anal sphincter injuries after training to protect the perineum: cohort study. BMJ Open 2012; 2: e001649
- 17 Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database Syst Rev 2009; (1) CD000081
- 18 Wheeler 2nd TL, Richter HE. Delivery method, anal sphincter tears and fecal incontinence: new information on a persistent problem. Curr Opin Obstet Gynecol 2007; 19: 474-479
- 19 Gurol-Urganci I, Cromwell DA, Edozien LC et al. Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors. BJOG 2013; 20: 1516-1525