Guidelines for the Management of Third and Fourth Degree Perineal Tears After Vaginal Birth

Abstract

Introduction: The purpose of these guidelines is to provide help in decision-making concerning the diagnosis, treatment and follow-up of patients with higher grade perineal tears (perineal tears grades 3 and 4) and thus minimise the risk for persisting complaints. Methods: In 2007 the Austrian Urogynecology Working Group (Arbeitsgemeinschaft für Urogynäkologie und rekonstruktive Beckenbodenchirurgie Österreich [AUB]) published the “Guidelines for Management of 3rd and 4th Grade Perineal Tears after Vaginal Delivery” („Leitlinie zum Management von Dammrissen III. und IV. Grades nach vaginaler Geburt“). In 2011 the guidelines were updated including literature appearing up to publication date November 30, 2011. The realisation of consensus was supported by the DELPHI method. Results: Evidence-based recommendations founded on consensus were presented on the topics epidemiology, risk factors, classification, diagnosis, surgical management and follow-up of higher grade perineal tears (grade 3 and 4 perineal tears) after vaginal delivery.

Zusammenfassung

Einleitung: Ziel dieser Leitlinie ist es, eine Entscheidungshilfe für Diagnose, Behandlung und Nachsorge von Patientinnen mit höhergradigen Dammrissen (Dammriss III. und IV. Grades) zu geben und so das Risiko für dauerhafte Beschwerden zu minimieren. Methodik: Im Jahr 2007 wurde von der Arbeitsgemeinschaft für Urogynäkologie und rekonstruktive Beckenbodenchirurgie Österreich (AUB) die „Leitlinie zum Management von Dammrissen III. und IV. Grades nach vaginaler Geburt“ erstellt. 2011 wurde die Leitlinie aktualisiert, wobei Literatur mit Erscheinungsdatum bis 30. November 2011 eingeschlossen wurde. Die Konsensusfindung wurde durch die DELPHI-Methode unterstützt. Ergebnisse: Evidenzgestützte, auf Konsens basierende Empfehlungen wurden erstellt zu Epidemiologie, Risikofaktoren, Einteilung, Diagnose, chirurgische Versorgung sowie die Nachsorge zum Thema höhergradiger Dammriss (Dammriss III. und IV. Grades) bei vaginaler Geburt.

Key words

delivery - birth trauma - perineal tears - faecal incontinence

Schlüsselwörter

Geburt - Geburtstrauma - Dammriss - Stuhlinkontinenz

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