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Why Do Severe Perineal Tear Rates Vary?

Why Do Severe Perineal Tear Rates Vary?

Recent studies in Europe and the United States reveal the extent to which the experience of perineal tears differs across the developed world. What's going on?

What is a severe perineal tear?

A perineal tear is an injury to the perineum (the area between the vagina and the anus) that sometimes occurs during childbirth. A severe perineal tear is otherwise described as a 3rd or 4th degree tear. Whereas 1st and 2rd degree tears affect the skin and muscle, respectively, of the perineum, a 3rd degree tear continues across the perineum to affect the anal sphincter, and a 4th degree tear also damages the lining of the anal canal.

How do severe tear rates compare across the developed world?

As recently mentioned on these pages, research has showed that incidences of severe 3rd or 4th degree birth tears have been increasing in the UK, going from 1.8% of all births in 2000 to 5.9% of all births in 2011.

In contrast, research published in the United States in 2015 (Friedman AM et al.) demonstrated that 3rd and 4th degree tears had decreased from 5.7% in 1998 to 3.1% in 2010. This seems to be a rather extraordinary contrast that, over virtually the same time period, the incidence in one developed country had fallen, whereas the number had increased by similar amounts in another country at a similar level of development.

A further contrast is offered by looking at statistics for incidence of severe tears amongst women in Europe. Again, there appears to be a significant difference in levels of experience with Poland, France and Portugal reporting fewer than 1 per 100 women suffering a severe tear and Denmark and Iceland reporting rates of almost 5 women per 100.

Why might severe tear rates vary?

Generally, there seems to be agreement as to why perineal injuries occur that being an assisted delivery, a prolonged labour, a previous tear, a large baby and shoulder dystocia.

It would suggest, therefore, that where rates of tear differ, one of these factors might be at play. There may be a greater use of instrumental delivery in some countries or there may be a generally greater foetal size in other countries, for example.

Another possible explanation is that the accuracy of diagnosis of types of tear and the efficiency and methods for reporting tears differs from country to country. Where a country is reporting a rate of less than 1%, for example, it may be that their data is not entirely accurate.

The significance of episiotomies.

The view of the significance of episiotomies (deliberate cuts to the perineum to aid delivery) in increasing or decreasing the likelihood of a perineal tear also seems to vary. Recent Scandinavian research (Blondel B et al.), which gathered data across Europe, demonstrated a negative correlation between the rate of episiotomies and the rate of severe tears, suggesting that a decrease in the use of episiotomies might lead to an increase in the rate of 3rd or 4th degree tears. Likewise, the American research suggested that some tears might have been avoided but for a decrease in the use of episiotomies.

Elsewhere, the evidence is less clear as to the role of an episiotomy, suggesting that, whilst an episiotomy might reduce the likelihood of a smaller tear, it might increase the chances of a more severe tear.

Agreement over findings

There appears to be agreement that, unless all births are via caesarean section, perineal trauma will continue to occur and that it will continue to be very difficult either to predict or to prevent.

What is most important, perhaps, is to be aware of the problem and to ensure medical practitioners are fully trained in recognition and treatment. Thorough examination of the mother immediately after birth should take place, diagnosis of the precise grade of tear should be accurate, and appropriate treatment should be prompt. This means, for 3rd and 4th degree tears, a surgical repair in an operating theatre by a skilled surgeon.

On-going Problems

If you have continued to suffer long-term negative effects of a severe tear that was either misdiagnosed or inadequately treated, you may be able to make a claim for compensation.

Contact Glynns Solicitors to discuss your situation with a solicitor experienced in this field of litigation.

Please call us on 0800 234 3300 (or from a mobile 01275 334030) or complete our Online Enquiry Form.

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