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Assessing Perineal Trauma After Birth

Assessing Perineal Trauma After Birth

After a woman gives birth by way of vaginal delivery, the attending midwife or doctor must assess whether any perineal, genital or anal trauma has been sustained.

A failure to diagnose and repair a perineal birth injury could amount to medical negligence. If this has happened to you, please get in touch with us to discuss making a compensation claim.

Guidelines for assessing perineal tears

Both the NICE Intrapartum Care (2007) and the Royal College of Obstetricians and Gynaecologists Guideline on the Management of Third and Fourth Degree Perineal Tears (2007) state that all women having had a vaginal delivery with evidence of perineal trauma should have further systemic assessment.

Under the heading “recommendations on assessment of perineal trauma”, the NICE guidelines state:

Before assessing for genital trauma, healthcare professionals should:

  • Explain to the woman what they plan to do and why
  • Offer inhalational analgesia
  • Ensure good lighting
  • Position the women so that she is comfortable and so that the genital structures can be seen clearly

The initial examination should be performed gently and with sensitivity and may be done in the immediate period following the birth.

If genital trauma is identified following birth, further systemic assessment should be carried out, including a rectal examination.

Systemic assessment of genital trauma should include:

  • Further explanation of what the healthcare professional plans to do and why
  • Confirmation by the woman that tested effective local or regional analgesia is in place
  • Visual assessment of the extent of perineal trauma to include the structures involved, the apex of the injury and assessment of bleeding
  • A rectal examination to assess whether there has been any damage to the external or internal anal sphincter if there is any suspicion that the perineal muscles are damaged

Therefore the initial assessment, which every patient must have following a vaginal delivery, will check whether the labia and perineum are intact. If so, no further assessment is necessary.

But if there are signs of perineal injury, then it is accepted practice to proceed with a systemic assessment to include a rectal examination. It is difficult to diagnose a third or fourth degree tear by visual assessment and a rectal examination must be undertaken to reduce missing such an injury.

Failure to spot perineal injury

If medical practitioners fail to spot the signs of perineal injury, and so do not perform a thorough assessment, a third or fourth degree tear could be missed. This will amount to medical negligence.

If your 3rd or 4th degree tear was not recognised and repaired, please contact us for expert legal advice.

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