Misdiagnosed Perineal Tears

A spontaneous perineal tear is a common occurrence during childbirth and does not in itself represent a substandard level of care. However, what will be considered negligent is if medical professionals mistake extensive trauma for a more minor injury, thereby leaving a woman with a misdiagnosed tear.

Classifying a perineal tear

After a vaginal delivery, a new mother must be examined for perineal trauma. It does not matter if this is carried out by a midwife or a registrar; what matters is that a thorough examination does take place by a qualified professional to ensure the full extent of injury is identified. This includes assessing whether there is injury to the anal sphincter complex, both internal and external.

On initial visualisation, the perineal trauma may appear to be superficial (known as a first degree tear). However, it is possible for the trauma to extend deeply behind the intact perineal skin so that it actually reaches the anal sphincter (which will either be a third or fourth degree tear depending upon the severity of the injury). This type of trauma can be incorrectly diagnosed unless a thorough perineal and rectal examination is carried out.

Therefore to guarantee the correct diagnosis is made, all women who have delivered vaginally should undergo a systematic inspection of the perineum, vagina and rectum. This should involve a digital rectal examination, whereby a finger is inserted into the anus to check whether there is any defect.

Such a post-partum assessment will allow the precise nature of the injury to be identified, thereby providing medical professionals with the necessary information to diagnose the level of injury (ranging from a first degree tear to a fourth degree tear).

How can a perineal tear be misclassified?

Any reasonable, competent doctor or midwife should be able to perform this examination in order to identify the full extent of trauma sustained. However, there are sadly occasions in which women have sustained a third or fourth degree tear, but medical professionals have mistaken their injury for a more minor tear (such as a first or second degree tear).

This kind of misdiagnosis, whereby a perineal injury is 'under-diagnosed', can have very troubling complications. Indeed, a woman will leave hospital with an unrepaired injury which neither she nor doctors will even be aware of. Within weeks or months, she will soon develop problems such as faecal incontinence, faecal urgency and an inability to control flatus (wind).

Although the true extent of the deficiency may then be recognised with further investigation, it is likely that a secondary repair will have little effect. Women with severe perineal tears stand the best chance of recovery if a repair is carried out soon after the birth; if there is a delay and a secondary repair is performed, the prognosis for a full recovery is less favourable.

Claiming for a misdiagnosis

If medical professionals have failed to recognise your third or fourth degree tear after the birth of your child, it is very probable that you have been provided with a substandard level of care. This means you will be entitled to compensation for the damages you have incurred. For more information on making a medical negligence claim, get in touch and speak to one of our legal experts.

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