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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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Identifying Information
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 Name
 Obstetric Trauma: Vaginal Delivery Without Instrument
 Short/Other Names
 Obstetric Trauma (Without Instrument)
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Indicator Description and Calculation
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 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
 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)
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Background, Interpretation and Benchmarks
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 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.
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Availability of Data Sources and Results
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 Data Sources
 Available Data Years
 Type of Year: Fiscal First Available Year: 2012 Last Available Year: 2016
 Geographic Coverage
 All provinces/territories
 Reporting Level/Disaggregation
 National, Province/Territory, Region, Facility, Peer Group
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 Update Frequency
 Every year
 Indicator Results
 Web Tool: CIHI Health Indicators URL: https://www.cihi.ca/en/cihi-health-indicators
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