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Perineal Lacerations as Obstetric Quality Measure

What are the limitations?

The American College of Obstetricians and Gynecologists’ (ACOG) Committee on Obstetric Practice has issued a committee opinion on the limitations of perineal lacerations as an obstetric quality measure. According to the committee, the rate of severe perineal lacerations should not be used as a measure of obstetric quality for the following reasons:

• Third-degree and fourth-degree perineal lacerations may not be defined uniformly.

• Severe perineal lacerations are associated strongly with nonmodifiable risk factors.

• Diminishing the use of operative vaginal delivery, in an effort to decrease severe perineal lacerations, likely would result in an increased rate of cesarean delivery.

Measuring the rate of episiotomy with unassisted vaginal deliveries is an alternative candidate for quality measurement, but it requires validation before widespread implementation.

Citation: Limitations of perineal lacerations as an obstetric quality measure. Committee Opinion No. 647. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015;126:e108-111.