Severe Perineal Lacerations in Obstetric Practice: The Effect of Institutional Practice Guidelines on Repair Failures in a Single Centre.

Shamir O Cawich,Carol Rattray,Santosh Kulkarni,Ian Bambury,Loxley Christie,Vijay Naraynsingh,Dwayne Wright

doi:10.1155/2014/131682

Shamir O Cawich, Carol Rattray + Show 5 more

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https://doi.org/10.1155/2014/131682

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Abstract

Background. There is a high incidence of failure after repair of severe perineal lacerations (SPLs). A tertiary referral hospital in the Caribbean introduced guidelines in an attempt to improve outcomes. We performed an audit of SPL repairs at this centre in an attempt to determine the effect on repair failure. Methods. All patients with SPL repairs between November 1, 2007, and December 30, 2012, were identified. The primary aim was to determine the incidence of failed repairs (wound dehiscence, anal sphincter disruption, rectovaginal fistula, and/or faecal incontinence). The Cleveland Clinic Incontinence Score (CCIS) was used to assess continence at discharge and 24 weeks after repair. Data were analyzed with SPSS version 12. Results. There were 8108 vaginal deliveries, 23 third-degree injuries, and 3 fourth-degree injuries. Three patients experienced a repair failure. Notably, 69% of surgeons chose an inappropriate suture for sphincter repair. Conclusions. Experienced operators are performing repairs, but there is a high prevalence of inappropriate suture choice for repairs. A targeted educational campaign may be necessary to remind clinicians of the best practice in repair techniques.

Highlights

Women develop severe perineal lacerations (SPLs) involving the anal sphincters during 0.5% [1,2,3] to 6% [4] of vaginal deliveries
A rectovaginal fistula results from perineal wound dehiscence and sphincter disruption leads to faecal incontinence
Severe perineal lacerations occurred in women (0.32%) at a mean age of ± 5.78 years

Summary

Introduction

Women develop severe perineal lacerations (SPLs) involving the anal sphincters during 0.5% [1,2,3] to 6% [4] of vaginal deliveries. In these circumstances, an urgent perineal repair is required. The audit identified three pitfalls in SPL repair that could be changed: inexperienced operators, inappropriate suture choice, and inappropriate repair techniques [5] These were addressed through continuing education for clinicians in obstetric practice and policy change mandating repair by experienced staff and the development of institutional guidelines for SPL repair [6,7,8,9]. A targeted educational campaign may be necessary to remind clinicians of the best practice in repair techniques

Methods

Results

Conclusion