Principles of assessment of childbirth injury

Abstract

Perineal trauma is the most common type of maternal morbidity encountered by healthcare professionals, and it may result in significant effects on quality of life. An understanding of relevant anatomy is necessary for a full evaluation of the underlying trauma, and the extent of a tear will be classified according to the structures involved. Assessment requires good lighting, good analgesia and good positioning of the patient to ensure adequate visualization. The available evidence suggests that structured and multi-professional training enhances detection of severe perineal trauma. Limited evidence suggests that ultrasound imaging of the anal sphincter may also improve detection, but this is an area that will require further study to more precisely delineate its role in management.