Perineal trauma following childbirth affects around 70% of women (Greenshields and Hulme, 1993). The two main sources of trauma are due equally to either episiotomy (surgical incision of the perineum) or to a spontaneously occurring tear. Perineal tears vary in size and are graded from first degree (the most minor) to fourth degree (most severe). First, third and fourth degree tears are all clearly defined by the anatomical structures involved and clearly describe the extent of the trauma incurred. However, second-degree tears can vary widely in size and are often given the subjective descriptions of small, medium and large. Approximately 25–35% of all childbearing women sustain a second-degree perineal tear during childbirth but research and audit of the most appropriate aftercare for the wound has been restricted by the inability to provide a more objective measurement of second-degree tears. The Birmingham Perineal Research Evaluation Group has developed a tool to provide an objective measurement of second-degree tears. This paper describes the development of the tool and its validation that showed substantial levels of agreement between two midwives measuring the depth and length of perineal tears (n=130). The assessment tool does not cause any distress to the woman and is quick and easy to use, which should assist its use and uptake by clinically-based midwives. The use of this tool will provide the first objective method of assessing second-degree perineal tears that can be used in clinical practice to assist education, research and audit.
ObjectivesTo determine the extent to which a sample of NHS labor induction leaflets reflects evidence on labor induction.SettingAudit of labor induction patient information leaflets—local from WILL trial (When to Induce Labor to Limit risk in pregnancy hypertension) internal pilot sites or national-level available online.MethodsDescriptive analysis [n = 21 leaflets, 19 (one shared) in 20 WILL internal pilot sites and 2 NHS online] according to NHS “Protocol on the Production of Patient Information” criteria: general information (including indications), why and how induction is offered (including success and alternatives), and potential benefits and harms.ResultsAll leaflets described an induction indication. Most leaflets (n = 18) mentioned induction location and 16 the potential for delays due to delivery suite workloads and competing clinical priorities. While 19 leaflets discussed membrane sweeping (17 as an induction alternative), only 4 leaflets mentioned balloon catheter as another mechanical method. Induction success (onset of active labor) was presented by a minority of leaflets (n = 7, 33%), as “frequent” or in the “majority”, with “rare” or “occasional” failures. Benefits, harms and outcomes following induction were not compared with expectant care, but rather with spontaneous labor, such as for pain (n = 14, with nine stating more pain with induction). Potential benefits of induction were seldom described [n = 7; including avoiding stillbirth (n = 4)], but deemed to be likely. No leaflet stated vaginal birth was more likely following induction, but most stated Cesarean was not increased (n = 12); one leaflet stated that Cesarean risks were increased following induction. Women's satisfaction was rarely presented (n = 2).ConclusionInformation provided to pregnant women regarding labor induction could be improved to better reflect women's choice between induction and expectant care, and the evidence upon which treatment recommendations are based. A multiple stakeholder-involved and evidence-informed process to update guidance is required.
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