title: Severe Perineal Lacerations in Obstetric Practice: The Effect of Institutional Practice Guidelines on Repair Failures in a Single Centre.
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.
authors.affiliation: Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago.
authors.forename: Shamir O
authors.initials: SO
authors.lastname: Cawich
authors.affiliation: Department of Obstetrics and Gynaecology, University of the West Indies, Mona Campus, Kingston, Jamaica.
authors.forename: Dwayne
authors.initials: D
authors.lastname: Wright
authors.affiliation: Department of Obstetrics and Gynaecology, University of the West Indies, Mona Campus, Kingston, Jamaica.
authors.forename: Santosh
authors.initials: S
authors.lastname: Kulkarni
authors.affiliation: Department of Obstetrics and Gynaecology, University of the West Indies, Mona Campus, Kingston, Jamaica.
authors.forename: Carol
authors.initials: C
authors.lastname: Rattray
authors.affiliation: Department of Obstetrics and Gynaecology, University of the West Indies, Mona Campus, Kingston, Jamaica.
authors.forename: Ian
authors.initials: I
authors.lastname: Bambury
authors.affiliation: Department of Obstetrics and Gynaecology, University of the West Indies, Mona Campus, Kingston, Jamaica.
authors.forename: Loxley
authors.initials: L
authors.lastname: Christie
authors.affiliation: Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago.
authors.forename: Vijay
authors.initials: V
authors.lastname: Naraynsingh