Perineal trauma following childbirth: Development of an assessment tool

Katie Yiannouzis, Clare Gomme and Rosina Ullman


During the 1990's there has been an increasing unexplained trend among midwives not to suture some second-degree tears, which would have previously been repaired. This change in practice has evolved on the strength of limited evidence and practitioners often disagree on what constitutes a tear which needs suturing. The purpose of this study was to develop a tool to ensure a unified approach to the assessment of perineal trauma. The tool could also be used to enhance the validity of an evaluation of suturing and non-suturing of second-degree trauma. The presentation will concentrate on the development and testing of the assessment tool.

As this was a concern arising directly out of practice, a collaborative research design was used. The first phase of the project involved taking a range of photographs of perineal trauma, prior to repair. Women were informed about the study in the antenatal period and 40 consented to take part. The photographs obtained were then used in focus group discussions with midwives to encourage them to articulate precisely the criteria they used for assessing perineal trauma. The data from these focus groups were used to develop the perineal assessment tool. The tool was then introduced into practice and assessed for reliability. In a pilot study, the tool was tested, by the attending midwife and a researcher, on a convenience sample of 52 women with perineal trauma. Although the results of the pilot study are encouraging, with high levels of agreements between the two assessors, statistical analysis (using Cohen's Kappa ) indicates that the tool had not been tested across the full range of perineal trauma, as most of the tears assessed were moderate. Further testing is needed with a significant sample of women with both minimal and extensive trauma.

Correspondence to Katie Yiannouzis, Consultant Midwife, King's College Hospital, Denmark Hill, London SE5 9RS tel 020 7346 1517