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Perineal Assessment After Vaginal Delivery

After a vaginal delivery, it is important medical professionals perform a genital and rectal examination. This is a requirement, as it is the only way to accurately assess the extent of perineal and sphincter trauma. If medical professionals fail to carry out such an assessment and a woman leaves hospital with an undiagnosed tear, there will be grounds for a medical negligence claim.

Identifying Perineal Tears After Birth

Perineal tears following obstetric trauma are classified as first, second, third and fourth degree tears. Third degree tears involve the anal sphincter, with severe third degree tears (classified as 3C tears) incorporating a tear to the entire internal and external sphincter. A fourth degree tear extends through into the rectum or anal canal.

NICE Guidelines state clearly that systematic assessment of genital trauma should be performed if there is any obstetric trauma. This includes careful visual assessment of the extent of the perineal trauma, and rectal examination to assess whether there has been any damage to the sphincter. It also states that the woman should be referred to a more experienced health care professional if uncertainty exists as to the extent of trauma sustained. This will ensure that any perineal tears are correctly diagnosed and repaired.

What Happens If A Perineal Tear Is Missed?

A sphincter injury that is appropriately repaired immediately is likely to prevent or at least reduce symptoms associated with a sphincter injury in the long-term. If the injury to the sphincter is missed at the time of delivery a delayed repair of the internal sphincter cannot be carried out later, and only an external repair is possible. This is, however, associated with poor long-term outcome. A woman is consequently likely to suffer impaired faecal incontinence for the rest of her life.

Will This Amount To Medical Negligence?

Failure to adequately examine the perineum following a vaginal delivery and in so doing missing a sphincter injury will represent a breach of duty. This means that in failing to examine and identify a sphincter injury, medical professionals will have provided you with a substandard level of medical care. You will therefore be considered the victim of medical negligence, and will be legally entitled to claim compensation for the damage this has caused.

If your perineal tear was missed because medical professionals did not carry out a post-partum examination, you need to speak to a solicitor who specialises in medical negligence as soon as possible.

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