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Labour and Delivery Posters
An evaluation of the impact of rcog guidance on the recognition of severe perineal trauma
  1. S McClean1,
  2. D Farrar2,
  3. D Tuffnell1
  1. 1Women's and Newborn Unit, Bradford, United Kingdom
  2. 2Bradford Institute for Health Research, Bradford, United Kingdom


Background In 2007 the Royal College of Obstetricians and Gynaecologists (RCOG) recommended that women with genital tract trauma sustained during vaginal birth should undergo a systematic assessment including a rectal examination to assess the severity of damage prior to suturing.

Objectives To evaluate the impact of RCOG guidance on the proportion of women receiving a systematic examination prior to suturing of genital tract trauma and assess the proportion of severe perineal trauma identified.

Methods A random sample of obstetric records were reviewed for the three years before (2004-2006) and following College guidance (2008-2010) to determine the proportion of women with second degree tears who had undergone a pre-repair systematic examination. Prospectively collected data on all third and fourth degree tears were examined within the study years.

Results From 2004 to 2006, 3% of women had documented evidence of a pre-repair systematic assessment, this increased to 33% between 2008 and 2010. Third degree tears were identified in 1% (189/13,880) of women between 2004 and 2006 and 2% (345/14,654) between 2008 and 2010. The rate of fourth degree tears was unchanged (0.1%).

Conclusions RCOG guidance on pre-repair examination led to an increase in the proportion of women undergoing a pre-repair systematic assessment including rectal examination, this was associated with doubling of the proportion of severe perineal trauma identified. Work to increase the rate of documented pre-repair systematic examination may increase the identification of severe trauma further.

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