Perineal Laceration Documentation and Suturing Protocol

A protocol for documentation of perineal lacerations and suturing after vaginal delivery was developed (see Figure S1 in electronic supplementary material). The protocol contains information about perineal trauma as a risk factor for future pelvic floor symptoms, including degree of perineal tear, episiotomy, anterior lacerations and labial lacerations, and specific information regarding suturing of the different lacerations. The protocol was developed to fulfill the needs of a future cohort study of pelvic floor dysfunction in women delivering their first child. The protocol uses the Royal College of Obstetricians and Gynecologists classification of perineal lacerations [8 ], and the distinction between low and high obstetric vaginal laceration is based on the ICD-10 classification [9 ]. Regarding other obstetric vulvar trauma, we used our own clinical experience when developing the questions in the protocol. We aimed to construct a legible protocol configured as a checklist in order to minimize loss of information. A group of midwives and obstetricians at our Department of Obstetrics and Gynecology reviewed the protocol and gave feedback regarding the content and design of the protocol.
All women delivering their first child vaginally from 13 October 2015 to 1 February 2016 at Örebro University Hospital were eligible for the study. The women were included consecutively. The approximate sample size required was estimated based on clinical and scientific experience. No formal power calculation was pursued when planning the study. After delivery the midwife or, where appropriate, the obstetrician in charge documented the perineal laceration and suturing both in the protocol mentioned above and simultaneously in the regular computerized obstetric record system (ObstetriX, Siemens, version 2.14.02.200). In ObstetriX, the midwife documents perineal lacerations and vaginal ruptures in the computerized sheet “Delivery care 1” (Förlossningsvård 1, see Table S1 in electronic supplementary material). In the case of a more extensive perineal tear or vaginal rupture that is sutured by an obstetrician, the obstetrician will document the injury and the suturing in the protocol “Suturing of delivery-related injury” (Sutur av förlossningsskada; see Table S2 in electronic supplementary material). When finishing the documentation regarding a third- or fourth-degree perineal tear, a pop-up window appears with a list and descriptions of the diagnostic codes of third- and fourth-degree perineal tears according to ICD-10, allowing the obstetrician to choose one. The ICD-10 diagnostic codes correspond to the Royal College of Obstetricians and Gynecologists’ classification of perineal tears [8 ]. In the present study, the main author extracted data from the medical record using an accessory program called ObstetriX Delivery Ward Ledger (ObstetriX Förlossningsliggare, version 2.14.02.200, Siemens). To achieve the subclassification of third-degree perineal tears into A, B, and C, the diagnostic code was extracted manually from the medical record.