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Third degree tears: the impact of audit upon clinical practice
  1. RL O'Donnell,
  2. L Mamatha,
  3. CDB Love
  1. Royal Infirmary of Edinburgh, Edinburgh, UK


Perineal trauma is a known risk of childbirth complicating 1% of all vaginal deliveries.

A review of all third degree tears over 9 years in a tertiary centre, demonstrated a rising incidence, which was out of proportion with the growing birth rate. The increase in incidence was statistically significant, (χ2, p<0.001), prompting an audit of clinical practice.

The initial audit from 2006 to 2008, n=291, identified inadequacies of the documentation of the classification of tear and its repair. There was also poor compliance with the recommended intraoperative antibiotics, postnatal antibiotics and laxatives and documentation of the postnatal consultation.

The initial audit resulted in revision of the local guideline, simplification of the antibiotic regime, and dissemination of the poor results within the department.

The re-audit from 2008 to 2009, n=335, demonstrated positive results with statistically significant (p<0.05) improvements in the documentation of tear classification, suture materials used and the use of the correct postoperative laxatives. There were numerical, but not statistically significant, improvements in the documentation of the repair method of the external anal sphincter and there was a statistically significant reduction in the lack of documentation of the postnatal follow-up.

This audit demonstrates the successful impact of audit upon clinical practice. The simplification and redistribution of a pan-trust guideline may also have a role in reducing inconsistencies and improving compliance. The authors would recommend audit of third degree tears in all Obstetric units to identify areas of improvement which can ultimately improve clinical practice.

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