Misdiagnosing Perineal Tears
The number of perineal tears experienced by women during childbirth in the UK appears to be on the rise, as is the number of compensation claims for long-term damage. Frequently, these claims result from a failure by medical practitioners to diagnose the tear correctly at the time of birth.
Examining for a perineal tear
The guidelines issued by The Royal College of Obstetricians and Gynaecologists state that 'all women having a vaginal delivery are at risk of sustaining OASIS (obstetric anal sphincter injuries) or isolated rectal buttonhole tears. They should therefore be examined systematically, including a digital rectal examination, to assess the severity of damage.'
Effects of an undiagnosed severe tear
A failure to examine and a failure to recognise a severe tear can lead to a lack of treatment and, for the woman concerned, this can have devastating consequences.
Where a severe birth tear is not repaired, the woman might develop some or all of the following appalling symptoms:
- Inability to control the passing of wind (wind incontinence)
- Inability to control the passing of faeces (bowel incontinence)
- Leakage of faeces via the vagina
- Discomfort during sexual intercourse
- Inability to keep the perineal area clean
- On-going infections
It is also likely that, once the tear is finally diagnosed, the woman will need surgery to try to resolve the damage. By this time, it may be too late to have much impact and her symptoms may continue.
Diagnosing perineal tears
In the immediate aftermath of a birth, bleeding may make diagnosis of a tear difficult but it is a vital process and the RCOG guidelines are clear that 'if there is any doubt about the degree of third degree tear, it is advisable to classify it to the higher degree rather than the lower degree.
Tears are classified according to the following descriptions and treated accordingly.
- 1st degree tear - injury to perineal skin and/or vagina mucosa
- 2nd degree tear – injury to perineal muscles but not including the anal sphincter
- 3rd degree tear – injury to the perineum and anal sphincter complex (with subset grades of third degree tears:
- 3a – less than 50% of external sphincter thickness torn
- 3b – more than 50% external sphincter thickness torn
- 3c – both external and internal sphincter torn
- 4th degree tear – injury to perineum involving anal sphincter and anal mucosa
Clarity about the extent of the tear and an accurate description and record are vital to ensure the mother receives the appropriate repair. Repairing a third or fourth degree tear as if it were a 2nd degree tear will leave the mother with continuing symptoms and the possibility of developing a fistula (hole) between the anus and vagina.
Medical Negligence
Where an examination did not take place after the delivery of the baby, and a severe tear was missed, the mother may be able to make a claim for compensation for her pain and on-going symptoms.
Glynns Solicitors specialise in medical negligence and have years of experience of supporting birth injury claims. Contact us to discuss your circumstances.
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