Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Int Urogynecol J. 2022 Jun;33(6):1463-1472. doi: 10.1007/s00192-021-05062-9. Epub 2022 Feb 3.
Obstetric lacerations complicate the majority of deliveries. The application of standardized guidelines for assessing delivery trauma has not been assessed thoroughly in the United States. We recently identified gaps in US midwives' clinical assessment of delivery trauma. We conducted a cross-sectional national survey of practicing obstetricians in the USA to characterize their classification of obstetric lacerations. We hypothesized that attending obstetricians' identification and diagnosis of delivery trauma would be similar to our findings for midwives with frequent inaccuracy.
We recruited clinically active obstetricians through the Pregnancy-Related Care Research Network. We asked participants to classify (from written definitions) and diagnose (from standard illustrations) common forms of vaginal delivery trauma using the widely employed perineal laceration degree system. We performed bivariate analysis of high- and low-scoring respondents and logistic regression to model characteristics associated with higher diagnostic accuracy.
Of the 162 respondents who started the survey, 76% (123) were included for analysis (22% of solicited emails). Overall, we found wide variation in response accuracy with as few as 62% of respondents correctly classifying certain types of lacerations. Only 49 out of 123 (40%) use the Sultan third-degree subclassification system and 67 out of 123 (52%) continue to use the midline/median approach for episiotomies. Providers reporting fewer deliveries per month and fewer publicly insured patients earned higher scores.
Obstetricians in a nationally representative US perinatal provider network inconsistently identify perineal and nonperineal lacerations. We found important clinical knowledge gaps, suggesting that vaginal delivery diagnoses in obstetric quality studies and pelvic floor research might be inaccurate.
产科裂伤使大多数分娩复杂化。在美国，尚未彻底评估用于评估分娩创伤的标准化指南的应用。我们最近发现美国助产士在分娩创伤临床评估方面存在差距。我们对美国执业产科医生进行了横断面全国性调查，以描述他们对产科裂伤的分类。我们假设，主治产科医生对分娩创伤的识别和诊断与我们对助产士的发现相似，存在频繁的不准确性。
我们通过妊娠相关护理研究网络招募了临床活跃的产科医生。我们要求参与者使用广泛使用的会阴裂伤程度系统，根据书面定义对常见的阴道分娩创伤进行分类（从书面定义）和诊断（从标准插图）。我们对高得分和低得分的受访者进行了双变量分析，并进行了逻辑回归分析，以建立与更高诊断准确性相关的特征模型。
在开始调查的 162 名受访者中，有 76%（123 名）被纳入分析（占征求电子邮件的 22%）。总体而言，我们发现反应准确性差异很大，只有 62%的受访者能够正确分类某些类型的裂伤。只有 123 名受访者中的 49 名（40%）使用 Sultan 三度亚分类系统，而 123 名受访者中的 67 名（52%）继续使用会阴切开术的中线/中央方法。报告每月分娩次数较少和有更多公共保险患者的提供者得分较高。
在具有全国代表性的美国围产期提供者网络中，产科医生不能一致地识别会阴和非会阴裂伤。我们发现了重要的临床知识差距，这表明在产科质量研究和盆底研究中，阴道分娩诊断可能不准确。
