Diagnosing Perineal Tears, Does Different Assessment Methods Affect the Midwife's Clinical Judgement of Perineal Tears?

Diagnosing Perineal Tears, Does Different Assessment Methods Affect the Midwife's Clinical Judgement of Perineal Tears?

Diagnosing Perineal Tears. Consistency in Midwifes Clinical Judgement When Assessing Perineal Tears Using Two Different Assessment Methods.

Perineal injuries are one of the traumas most frequently suffered by women during delivery.Countries report wide variations in trauma rates, and within countries further variations exists among institutions and also among professional groups of caregivers.Visual and digital examination of the wound has been and is the most common way to assess and classify a perineal tear. However resent studies indicate that many tears diagnosed with this method are misclassified.The suggested reasons for this, apart from the fact that bleeding and tissue oedema make the diagnose difficult, is that many healthcare providers have too little training in perineal assessment and basic anatomy. In this prospective randomised trial consenting women will be randomised in to the common visual and digital assessment of the perineal tear by to different midwives, blinded to each others assessment or visual and digital assessment and measuring of the tear with a small soft ruler, Peri-Rule also by two different midwives.

Four measurements will be used in this study. Depth of tear, from the fourchette into the greatest depth of the perineal body. Length of tear, from the fourchette to the apex of the vaginal tear. Length of tear, from the fourchette along perineal skin towards the anus. Length of the perineal body, from the fourchette to outer margin of anus.

Midwifes assessing perineal tears as standard procedure with visual and digital examination of the perineal tear.

To investigate how different assessment methods affected the midwives´ clinical judgement between different midwife practitioners when they classify and evaluate perineal tears.

Two different midwife practitioners' assess the same perineal tear and fill out an assessment protocol independently.

Inclusion Criteria: Spontaneous vaginal birth Women over 18 years of age Healthy Child Written consent signed by participant Spontaneous tear in perineum that involves the perineal skin Exclusion Criteria: Bleeding from tears that demand suturing immediately. Bleeding that affected the general condition negatively Complex tears that branched out in two or more different directions Women delivered instrumentally forceps or ventouse Women delivered with Cesarian section Women who sustain episiotomy