Indicator Metadata

Obstetric Trauma: Vaginal Delivery Without Instrument

Obstetric Trauma (Without Instrument)

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 (PDF).

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

Place of service

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 (PDF) document.

Logistic regression

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

8. 2018–2019 data onward: Medical assistance in dying (MAID) (Discharge Disposition Code = 73)

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, O70.211, O70.221, O70.231, O70.281, O70.291)
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:
   1. Of corpus uteri (CCI code: 5.PC.80.JH)
   2. Of current obstetric laceration of cervix occurring at vaginal delivery (CCI code: 5.PC.80.JJ)
   3. Of current obstetric laceration of bladder and urethra (CCI code: 5.PC.80.JR)
   4. Of current obstetric laceration of rectum and sphincter ani (CCI code: 5.PC.80.JQ)
   5. Of current obstetric high vaginal laceration (CCI code: 5.PC.80.JU)
   6. Of current obstetric laceration of broad ligament(s) of uterus (CCI code: 5.PC.80.JL)

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.

Lower rates are desirable.

Health System Outputs: Safe

Getting Better

Not applicable

Canadian Institute for Health Information. Patient Safety in Canada: An Update (PDF). 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.

DAD, HMDB

Type of Year:
Fiscal
First Available Year:
2013
Last Available Year:
2018

All provinces/territories

National, Province/Territory, Region, Facility, Peer Group

Every year

Web Tool:
CIHI Health Indicators
URL: https://www.cihi.ca/en/cihi-health-indicators (click "Additional Acute Care indicators")

Not applicable

Not applicable

Not applicable

Indicator results are also available in

• Your Health System: Insight, updated monthly
• The Health indicator reporting page of our website (click Additional Acute Care Indicators)