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Cawich SO, Wright D, Kulkarni S, et al. Severe Perineal Lacerations in Obstetric Practice: The Effect of Institutional Practice Guidelines on Repair Failures in a Single Centre. Int Sch Res Notices. 2014;2014:131682doi: 10.1155/2014/131682.
Cawich, S. O., Wright, D., Kulkarni, S., Rattray, C., Bambury, I., Christie, L., & Naraynsingh, V. (2014). Severe Perineal Lacerations in Obstetric Practice: The Effect of Institutional Practice Guidelines on Repair Failures in a Single Centre. International scholarly research notices, 2014131682. https://doi.org/10.1155/2014/131682
Cawich, Shamir O, et al. "Severe Perineal Lacerations in Obstetric Practice: The Effect of Institutional Practice Guidelines on Repair Failures in a Single Centre." International scholarly research notices vol. 2014 (2014): 131682. doi: https://doi.org/10.1155/2014/131682
Cawich SO, Wright D, Kulkarni S, Rattray C, Bambury I, Christie L, Naraynsingh V. Severe Perineal Lacerations in Obstetric Practice: The Effect of Institutional Practice Guidelines on Repair Failures in a Single Centre. Int Sch Res Notices. 2014 Oct 29;2014:131682. doi: 10.1155/2014/131682. eCollection 2014. PMID: 27350967; PMCID: PMC4897495.
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Int Sch Res Notices. 2014 Oct 29;2014:131682. doi: 10.1155/2014/131682. eCollection 2014.

Severe Perineal Lacerations in Obstetric Practice: The Effect of Institutional Practice Guidelines on Repair Failures in a Single Centre.

International scholarly research notices

Shamir O Cawich, Dwayne Wright, Santosh Kulkarni, Carol Rattray, Ian Bambury, Loxley Christie, Vijay Naraynsingh

Affiliations

  1. Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago.
  2. Department of Obstetrics and Gynaecology, University of the West Indies, Mona Campus, Kingston, Jamaica.

PMID: 27350967 PMCID: PMC4897495 DOI: 10.1155/2014/131682

Abstract

Background. There is a high incidence of failure after repair of severe perineal lacerations (SPLs). A tertiary referral hospital in the Caribbean introduced guidelines in an attempt to improve outcomes. We performed an audit of SPL repairs at this centre in an attempt to determine the effect on repair failure. Methods. All patients with SPL repairs between November 1, 2007, and December 30, 2012, were identified. The primary aim was to determine the incidence of failed repairs (wound dehiscence, anal sphincter disruption, rectovaginal fistula, and/or faecal incontinence). The Cleveland Clinic Incontinence Score (CCIS) was used to assess continence at discharge and 24 weeks after repair. Data were analyzed with SPSS version 12. Results. There were 8108 vaginal deliveries, 23 third-degree injuries, and 3 fourth-degree injuries. Three patients experienced a repair failure. Notably, 69% of surgeons chose an inappropriate suture for sphincter repair. Conclusions. Experienced operators are performing repairs, but there is a high prevalence of inappropriate suture choice for repairs. A targeted educational campaign may be necessary to remind clinicians of the best practice in repair techniques.

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