The Royal College of Obstetricians and Gynaecologists (RCOG) has recently published guidance on the diagnosis and management of third degree tears. This written policy should be followed in maternity units across England.
RCOG guidance for 3rd degree tears
The third edition of the RCOG guidance, ‘Third and Fourth degree Perineal Tears, Management’, has recently been published. It was formerly published under the same title in 2001 and 2007. The revised edition offers comprehensive advice upon the diagnosis, management and treatment of third degree tears, including:
- Classification and terminology of perineal tears
- Prediction and prevention of obstetric anal sphincter injury
- Identification of obstetric anal sphincter injuries
- Repair of perineal tears
- Choice of suture materials
- Surgical competence
- Postoperative management
- Future deliveries
- Risk management
Importance of following guidance
It is absolutely vital that maternity units heed this guidance, as it will ensure women receive proper care for a third degree tear. Sadly it is not possible to prevent a tear happening, so the best medical practitioners can do is to diagnose and treat the injury to the standards set out by RCOG.
This is particularly important because research suggests that the incidence of third and fourth degree tears in the UK is increasing. In 2000, the reported rate of obstetric anal sphincter injury in England was 1.8%. By 2012 this number had tripled to 5.9%.
The increase may in part be due to better detection and reporting of perineal tears. It may also be due to the rise in maternal age and weight, both of which raise the risk of a third degree tear.
Failure to provide adequate care
If medical practitioners fail to meet the standards set out by RCOG, it could result in devastating consequences for the patient concerned. Most worryingly, it may mean that the injury is missed and/or not repaired. Alternatively a tear may be detected by not properly classified.
Such errors will mean the obstetric anal sphincter injury remains in place. The sphincter cannot function normally with a tear in it, so the woman will start to experience the uncontrollable passage of wind and faeces.
Third degree tears will heal better if the injury is repaired quickly. Therefore a delay in diagnosis and treatment could mean the patient’s symptoms do not improve. This can have a terrible impact upon a woman’s physical and mental health, and can also make future deliveries an issue.
If a patient is harmed because medical practitioners fail to provide an acceptable standard of care, there may be grounds for a compensation claim. Contact us to find out more.