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Geburtshilfe Frauenheilkd 2015; 75(2): 145-147
DOI: 10.1055/s-0035-1545703
Statement
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

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?
H. B. G. Franz
1   Frauenklinik Klinikum Braunschweig, Braunschweig
,
C. W. J. Erxleben
2   Charité Universitätsmedizin Berlin, Berlin
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
16. März 2015 (online)

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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.

Key words

delivery - fecal incontinence - tear - external anal sphincter - quality

Schlüsselwörter

Geburt - anale Inkontinenz - Dammriss - externer analer Sphinkter - Qualität

Supporting Information

 

  • References

  • 1 Cunningham FG, Leveno K, Bloom S. Williams Obstetrics. 23rd. ed. New York: McGraw-Hill Professional; 2010
    Suche in Google Scholar
  • 2 Sultan AH, Thakar R, Fenner DE eds. Perineal and anal Sphincter Trauma. London: Springer; 2007
    CrossrefSuche in Google Scholar
  • 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
    CrossrefPubMedSuche in Google Scholar
  • 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
    Thieme ConnectPubMedSuche in Google Scholar
  • 5 Aqua-Institut GmbH. Qualitätsindikatoren Modul 16/1 – Geburtshilfe. Göttingen: Eigenverlag; 2013
    Suche in Google Scholar
  • 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
    CrossrefPubMedSuche in Google Scholar
  • 7 Andrews V, Sultan AH, Thakar R et al. Occult anal sphincter injuries – myth or reality?. BJOG 2006; 113: 195-200
    CrossrefPubMedSuche in Google Scholar
  • 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
    CrossrefPubMedSuche in Google Scholar
  • 9 Sultan AH, Kamm MA, Hudson CN. Anal sphincter function after delivery. N Engl J Med 1993; 329: 1905-1911
    CrossrefPubMedSuche in Google Scholar
  • 10 Dudding TC, Vaizey CJ, Kamm MA. Obstetric anal sphincter injury: incidence, risk factors, and management. Ann Surg 2008; 247: 224-237
    CrossrefPubMedSuche in Google Scholar
  • 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
    CrossrefPubMedSuche in Google Scholar
  • 12 Williams A, Tincello DG, White S et al. Risk scoring system for prediction of obstetric sphincter injury. BJOG 2005; 112: 1066-1069
    Suche in Google Scholar
  • 13 Gudmundsson S, Henningsson AC, Lindquist P. Correlation of birth injury with maternal height and birthweight. BJOG 2005; 112: 764-767
    CrossrefPubMedSuche in Google Scholar
  • 14 Eason E, Labrecque M, Wells G et al. Preventing perineal trauma during childbirth: a systematic review. Obstet Gynecol 2000; 95: 464-471
    CrossrefPubMedSuche in Google Scholar
  • 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
    PubMedSuche in Google Scholar
  • 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
    PubMedSuche in Google Scholar
  • 17 Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database Syst Rev 2009; (1) CD000081
    PubMedSuche in Google Scholar
  • 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
    CrossrefPubMedSuche in Google Scholar
  • 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
    PubMedSuche in Google Scholar