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

Kristin Cornell, Alison de Souza, Mark Tacey, David M. Long, Mayooran Veerasingham

Research output: Contribution to journalArticleResearchpeer-review

6 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)131-135
Number of pages5
JournalInternational Journal of Women's Health
Publication statusPublished - 5 May 2016
Externally publishedYes


  • Anal incontinence
  • Episiotomy
  • Guideline
  • Obstetric anal sphincter injury (OASI)
  • Perineal tear
  • Pro forma

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