Uustal Eva, Edqvist Malin
Department of Clinical and Experimental Medicine, Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden.
Department of Women's Health, Karolinska Institutet, Department of Women's Health and Allied Health Professions, Karolinska University Hospital, Stockholm, Sweden.
BMC Pregnancy Childbirth. 2025 Mar 11;25(1):272. doi: 10.1186/s12884-025-07371-z.
Perineal tears at delivery are common. The current WHO classification system compacts all the varying extents of second-degree tears into one code. Some tears lead to long-term injuries. The correct identification and classification of disease is necessary for correct clinical management as well as for research. Regulatory standards govern care practices. This article describes the process of creating and testing new subclassifications for second-degree tears at delivery.
The development and implementation of new subclassifications of second-degree perineal tears after delivery in Sweden are described. The new classification was tested for incidence and relevance via the national perineal laceration register (PLR) in 11,203 women with prospectively recorded second degree tears.
Second-degree tears after delivery are subdivided into four subgroups according to the anovaginal distance and the extent in length and depth of the largest perineal/vaginal tear, which can be combined with uni-or bilateral levator ani avulsion. Women with larger second-degree tears were more likely than women with smaller tears to report complications after eight weeks (OR 1.41 CI 1.21-1.64, p < 0.001) and one year (OR 1.27, CI 1.1-1.46, p < 0.001).
Detailed subclassifications of perineal and vaginal tears are implemented in the Swedish ICD-10 coding system and Swedish national registers. The outcomes after second-degree tears differ according to their extent, which corroborates the classification rationale. These subclassifications can be used in studies of preventive measures, treatment and patient-reported outcomes and experiences taking into account the extent of second-degree perineal tears at delivery.
Data regarding women were prospectively collected from the National perineal laceration register (PLR) from January 1, 2021, to December 31, 2022.
分娩时会阴撕裂很常见。世界卫生组织当前的分类系统将所有不同程度的二度撕裂归为一个代码。有些撕裂会导致长期损伤。正确识别和分类疾病对于正确的临床管理以及研究都很有必要。监管标准规范着护理实践。本文描述了为分娩时的二度撕裂创建和测试新亚分类的过程。
描述了瑞典产后二度会阴撕裂新亚分类的开发和实施情况。通过国家会阴撕裂登记册（PLR）对11203名有前瞻性记录的二度撕裂女性进行新分类的发病率和相关性测试。
产后二度撕裂根据肛门阴道距离以及最大会阴/阴道撕裂的长度和深度分为四个亚组，可与单侧或双侧肛提肌撕脱合并。二度撕裂较大的女性比撕裂较小的女性在八周后（比值比1.41，可信区间1.21 - 1.64，p < 0.001）和一年后（比值比1.27，可信区间1.1 - 1.46，p < 0.001）报告并发症的可能性更高。
瑞典的ICD - 10编码系统和瑞典国家登记册中实施了会阴和阴道撕裂的详细亚分类。二度撕裂后的结果因其程度而异，这证实了分类的基本原理。这些亚分类可用于考虑分娩时二度会阴撕裂程度的预防措施、治疗以及患者报告的结局和经历的研究。
关于女性的数据前瞻性地收集自2021年1月1日至2022年12月31日的国家会阴撕裂登记册（PLR）。
