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Name
Obstetric Trauma: Vaginal Delivery Without Instrument
Short/Other Names

Obstetric Trauma (Without Instrument)

Description

This indicator measures the rate of obstetric trauma (third-degree lacerations or greater in severity) for vaginal deliveries without instrument assistance.

For further details, please see the General Methodology Notes.

Interpretation
Lower rates are 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, Peer Group

Indicator Results

https://www.cihi.ca/en/cihi-health-indicators

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<div role="button" class="expandableTitle" aria-controls="identifyingInfoRegion">Identifying Information</div>
Name
Obstetric Trauma: Vaginal Delivery Without Instrument
Short/Other Names

Obstetric Trauma (Without Instrument)


<div role="button" class="expandableTitle" aria-controls="descAndCalRegion">Indicator Description and Calculation</div>
Description

This indicator measures the rate of obstetric trauma (third-degree lacerations or greater in severity) for vaginal deliveries without instrument assistance.

For further details, please see the General Methodology Notes.

Calculation: Description

The indicator is expressed as a rate of obstetric traumas per 100 unassisted 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 without the use of an instrument
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)
Exclusions:
1. Newborn, stillbirth or cadaveric donor records (Admission Category Code = N, R or S)
2. Records with invalid discharge date
3. Records with invalid age
4. 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)
5. Records with unknown or invalid (>45 completed weeks) gestational age
6. Caesarean sections (CCI code: 5.MD.60.^^)
7. 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)


<div role="button" class="expandableTitle" aria-controls="backgroundRegion">Background, Interpretation and Benchmarks</div>
Rationale

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

Risk factors for obstetric trauma include maternal age, large fetal size, prolonged pregnancy, long labour, malposition, episiotomy extraction and instrument assistance.

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

Lower rates are 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. 2007.

Organisation for Economic Co-operation and Development. Health at a Glance 2013: OECD Indicators. 2013.

Groutz A, Hasson J, Wengier A, et al. Third- and fourth-degree perineal tears: Prevalence and risk factors in the third millennium. American Journal of Obstetrics & Gynecology. 2011.

Handa VL, Blomquist JL, McDermott KC, et al. Pelvic floor disorders after childbirth: Effect of episiotomy, perineal laceration, and operative birth. Obstetrics & Gynecology. 2012.


<div role="button" class="expandableTitle" aria-controls="availabilityRegion">Availability of Data Sources and Results</div>
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, Peer Group


<div role="button" class="expandableTitle" aria-controls="resultRegion">Result Updates</div>
Update Frequency

Every year

Indicator Results

Web Tool:
CIHI Health Indicators
URL: https://www.cihi.ca/en/cihi-health-indicators

Updates

Not applicable


<div role="button" class="expandableTitle" aria-controls="qualityRegion">Quality Statement</div>
Caveats and Limitations

Not applicable

Trending Issues

Not applicable

Comments

Indicator results are also available in

Your Health System: Insight, updated monthly starting from 2012–2013

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