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Indicator Metadata

NameObstetric Trauma (With Instrument)
Short/Other Names

Obstetric Trauma: Vaginal Delivery With Instrument

Description

This indicator measures the rate of obstetric trauma (lacerations that are third degree or greater in severity) for instrument-assisted vaginal deliveries.

For further details, please see the General Methodology Notes.

InterpretationA lower rate is more desirable.
HSP Framework Dimension

Health System Outputs: Safe

Areas of Need

Getting Better

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Region, Facility

Indicator Results

Accessing Indicator Results on Your Health System: In Depth

Identifying Information
NameObstetric Trauma (With Instrument)
Short/Other Names

Obstetric Trauma: Vaginal Delivery With Instrument

Indicator Description and Calculation
Description

This indicator measures the rate of obstetric trauma (lacerations that are third degree or greater in severity) for instrument-assisted vaginal deliveries.

For further details, please see the General Methodology Notes.

Calculation: Description

The indicator is expressed as the rate of obstetric traumas per 100 instrument-assisted vaginal deliveries.

Risk-adjusted rate = Observed cases ÷ Expected cases × Canadian average

Unit of Analysis: Single admission

Calculation: Geographic Assignment

Place of service

Calculation: Type of Measurement

Rate - per 100

Calculation: Adjustment Applied

The following covariates are used in risk adjustment:
For a detailed list of covariates used in the model, please refer to the Model Specification document.

Calculation: Method of Adjustment

Logistic regression

Denominator

Description:
Vaginal delivery discharges with instrument-assisted delivery
Inclusions:
1. Admission to an acute care institution (Facility Type Code = 1)

2. Delivery code (ICD-10-CA: O10–O16, O21–O26, O28–O37, O40–O46, O48, O60–O75, O85–O92, O95 or O98–O99 with a sixth digit of 1 or 2 OR Z37 coded in any position)

3. Instrument-assisted vaginal delivery (CCI code: 5.MD.53^^, 5.MD.54^^, 5.MD.55^^, 5.MD.56.NN, 5.MD.56.PC, 5.MD.56.NR, 5.MD.56.PF, 5.MD.56.NW or 5.MD.56.PJ)
Exclusions:
1. Newborn, stillbirth or cadaveric donor records (Admission Category = N, R or S)

2. Records with invalid age

3. Records with unknown or invalid (>45 completed weeks) gestational age

4. Caesarean sections (CCI code: 5.MD.60.^^)

5. Delivery in which an abortive procedure was recorded (code may be recorded in any position; procedures not coded as "abandoned after onset" [Intervention Status Attribute = A]):

CCI: 5.CA.20.^^, 5.CA.24.^^, 5.CA.88.^^, 5.CA.89.^^, or 5.CA.93.^^

OR

ICD-10-CA: O04

Numerator

Description:
Cases within the denominator with obstetric trauma
Inclusions:
Cases within the denominator with at least one obstetric trauma (any of the following conditions or interventions):

1. Third-degree perineal laceration during delivery, delivered, with or without mention of antepartum condition (ICD-10-CA: O70.201)

2. Fourth-degree perineal laceration during delivery, delivered, with or without mention of antepartum condition (ICD-10-CA: O70.301)

3. Obstetric laceration of cervix, delivered, with or without mention of antepartum condition (ICD-10-CA: O71.301)

4. Obstetric high vaginal laceration alone, delivered, with or without mention of antepartum condition (ICD-10-CA: O71.401)

5. Other obstetric injury to pelvic organs, delivered, with or without mention of antepartum condition (ICD-10-CA: O71.501)

6. Other rupture of uterus during labour, delivered, with or without mention of antepartum condition (ICD-10-CA: O71.181)

7. Obstetric damage to pelvic joints and ligaments, delivered, with or without mention of antepartum condition (ICD-10-CA: O71.601)

8. Surgical repair, postpartum, of obstetric laceration:

a. Of corpus uteri (CCI code: 5.PC.80.JH)

b. Of current obstetric laceration of cervix occurring at vaginal delivery (CCI code: 5.PC.80.JJ)

c. Of current obstetric laceration of bladder and urethra (CCI code: 5.PC.80.JR)

d. Of current obstetric laceration of rectum and sphincter ani (CCI code: 5.PC.80.JQ)

e. Of current obstetric high vaginal laceration (CCI code: 5.PC.80.JU)

f. Of current obstetric laceration of broad ligament(s) of uterus (CCI code: 5.PC.80.JL)

Background, Interpretation and Benchmarks
Rationale

Obstetric trauma is among the most common adverse events in Canada. Obstetric trauma, including lacerations that are third degree and greater in severity, may result in longer lengths of stay for mothers, as well as chronic complications such as fecal incontinence, dyspareunia, perineal pain and other pelvic floor disorders.

Risk factors for obstetric trauma include prolonged pregnancy, long labour, malposition and maternal age. One of the most significant and potentially modifiable risk factors for obstetric trauma is the use of instruments during vaginal delivery. By ensuring appropriate training and adherence with best practice guidelines during instrument-assisted deliveries, hospitals can potentially reduce the risk of obstetric trauma.

The obstetric trauma indicators are intended to be used as flags to identify areas for improvement and to help identify processes of care that require hospital-level evaluation.

Interpretation

A lower rate is more desirable.

HSP Framework Dimension

Health System Outputs: Safe

Areas of Need

Getting Better

Targets/Benchmarks

Not applicable

References

Canadian Institute for Health Information. Patient Safety in Canada: An Update. Available at https://secure.cihi.ca/free_products/Patient_Safety_AIB_EN_070814.pdf. Updated August 14, 2007. Accessed February 12, 2014.

OECD. Health at a Glance 2013: OECD Indicators. Available at http://dx.doi.org/10.1787/health_glance-2013-en. Published November 21, 2013. Accessed February 12, 2014.

Groutz A, Hasson J, Wengier A, et al. Third-and fourth-degree perineal tears: prevalence and risk factors in the third millennium. Am J Obstet Gynecol. 2011;204(4): 347e1-347e4.

Handa VL, Blomquist JL, McDermott KC et al. Pelvic Floor Disorders After Childbirth: Effect of Episiotomy, Perineal Laceration, and Operative Birth. Obstet Gynecol. 2012;119(2 Pt 1):233-239.

Availability of Data Sources and Results
Data Sources

DAD, HMDB

Available Data Years

Type of Year:
Fiscal
First Available Year:
2013
Last Available Year:
2015

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Region, Facility

Result Updates
Update Frequency

Every year

Indicator Results

Web Tool:
Your Health System: In Depth
URL:
Accessing Indicator Results on Your Health System: In Depth

Updates

Not applicable

Quality Statement
Caveats and Limitations

Not applicable

Trending Issues

Not applicable

Comments

Not applicable