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As far as I know, it is possible that the inner tissue is damaged, without visible damage of the outer tissue. I assume that without being laconic it might be possible that the severity of the perineal damage is misjudged. It is desirable to define a procedure that reduces the possibility for misjudgment to the minimum, although I doubt it that misjudgment will be banished. Hartelijke groet, Susanne Besseling | e-mail: [log in to unmask]<mailto:[log in to unmask]> ________________________________ From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Marie Berg Sent: dinsdag 26 april 2011 13:53 To: [log in to unmask] Subject: SV: Missed Third Degree tears Hi We are running an RCT study in Fredrikstad, Norway focusing assessment of perineal tears. Kind regards Marie Berg, Sweden Marie Berg Professor in Health and Care Sciences Specializing in Reproductive and Perinatal Health Sahlgrenska Academy at University of Gothenburg Institute of Health and Care Sciences P O Box 457, SE 405 30 Gothenburg, Sweden +46 31 7866084, [log in to unmask]<mailto:[log in to unmask]> ________________________________ Från: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] För BARTON Andy, RDS Skickat: den 26 april 2011 13:00 Till: [log in to unmask] Ämne: Re: Missed Third Degree tears Hi all A small group of us (including Chris Kettle and Alison Metcalfe) got together a few years ago to work up a grant application for a trial investigating ways to improve midwives' assessment of perineal trauma sustained during delivery. I think time got the better of us and we didn't put in an application. Our own work on perineal suturing appeared to indicate poor assessment of the perineum at childbirth (Langley et al BJM 14(9), 550-554, 2006) but, not being a clinician, I've no idea whether this is still a live issue. If it is, I'd be delighted to coordinate an NIHR application to look at ways assessment could be improved. Any thoughts welcome - thanks. Bw a. -----Original Message----- From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Hung, Pak Y Sent: 18 April 2011 10:18 To: [log in to unmask] Subject: Re: Missed Third Degree tears Hi Sandra, Have at look at all the research work done by Chris Kettle at Keele University and Dr Sultan Gynae/Obstertician at Croydon Hospital. They have both published extensively in the British Medical Journal in the early- mid 2000's. Also Alison Metcalf, Sue Tohill & co researchers has also published her research on the use of a specially designed ruler to measure perineal tears to make a more accurate assessment/ differentiation of the perineal trauma. http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=8c31f9e0-041b-406 b-bd05-115ab9132864%40sessionmgr11&vid=16&hid=12 Rosina Ullman et al had trialled a perineal trauma assessment tool published in the British Journal of midwifery in 2004. Link- http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=6&hid=12&sid=8c31 f9e0-041b-406b-bd05-115ab9132864%40sessionmgr11 The PEARL study is also worth looking at for long term effects: http://wk6kg9sd8m.search.serialssolutions.com/?genre=article&title=BMC+P regnancy+And+Childbirth&atitle=PErineal+Assessment+and+Repair+Longitudin al+Study+(PEARLS)%3a+protocol+for+a+matched+pair+cluster+trial.&author=B ick+DE&authors=Bick+DE%3bKettle+C%3bMacdonald+S%3bThomas+PW%3bHills+RK%3 bIsmail+KM&date=20100225&volume=10&issue=&spage=10&issn=14712393 You can always go back to the audit work done by Christine McArthur in her book Health after childbirth published back in 1991 Regards, Pak Hung Senior Lecturer Midwifery Supervisors of Midwives University of Wolverhampton -----Original Message----- From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Ebanks Sandra Sent: 17 April 2011 10:08 To: [log in to unmask] Subject: Missed Third Degree tears Dear All, I am on the search for any evidence on the 'effects of poor assessment of the perineum' by midwives. For example if a midwife has documented that a 1st degree tear was sustained at delivery, and then several months later is having difficulty with bowel motions. Could this have been a third degree tear that was missed? Your information regarding this area of complexity will be very welcomed. Sandra This e-mail and any attachments may contain confidential and privileged information. If you are not the intended recipient, please notify the sender immediately by return e-mail, delete this e-mail and destroy any copies. 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