Can We Improve on the Diagnosis of Third Degree Tears?

Objectives: To assess if the clinical diagnosis of third degree tears could be improved by increased vigilance in perineal assessment.

Study Design: A prospective observational study of all nulliparous vaginal deliveries sustaining perineal trauma (483) over a 6-month period at Queen Charlotte's Hospital.

Results: A total of 121 women were independently assessed and compared to a control group (362). Both groups were similar for gestation at delivery, mode of onset of labour, analgesia used, duration of labour, mode of delivery, birthweight and head circumference. The overall rate of detected third degree tears increased from 2.5 (rate for 6 months prior to the study) to 9.3% during the study, P<0.001. There were significantly more third degree tears detected in the assessed group compared to the control group (14.9% versus 7.5%), P=0.01.

Conclusions: With increased vigilance, it is possible to improve on the clinical diagnosis of third degree tears. This study highlights the need for improvements in training of midwives and trainee doctors in perineal anatomy and recognition of severe trauma. Improvements in diagnosis allow appropriate repair which may lead to improvements in long-term outcome.