{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:38:16Z","timestamp":1789540696398,"version":"build-2803163510"},"reference-count":23,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2012,11,1]],"date-time":"2012-11-01T00:00:00Z","timestamp":1351728000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aust NZ J Obst Gynaeco"],"published-print":{"date-parts":[[2013,2]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The incidence of severe perineal tears acquired during vaginal childbirth varies considerably across hospitals but its use as a safety and quality indicator is in jeopardy because of problems associated with accurate detection and recording.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To understand and interpret time trends in the incidence of third\u2010 and fourth\u2010degree perineal tears among women giving birth vaginally in 18 public maternity hospitals in South Australia, taking into account individualised risk factors for each birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The risk\u2010adjusted probability of a third\u2010 and fourth\u2010degree tear was estimated for each of 65,598 singleton vaginal births (2002\u20132008), using a previously published regression model. The risk factors for each birth included maternal age; parity and ethnicity; assistance with instruments and episiotomy; shoulder dystocia; and infant birthweight. Plots of \u2018excess\u2019 tears were generated to help identify maternity services where the observed incidence of severe trauma differed from the expectation estimated from the risk profiles.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three hospitals were identified at which there were systematically more tears than expected (given their risk profiles), and five hospitals were identified at which there were fewer tears. However, increased tearing at two hospitals coincided closely with improved advocacy for better detection and treatment of perineal tears (especially partial third\u2010degree tears).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Statistical process control methods provide a powerful means of investigating temporal variations in the incidence of outcomes like severe perineal tears. Third\u2010 or fourth\u2010 degree tears should be retained as a quality indicator of maternity services, but it is likely that many third\u2010degree tears currently go undetected.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ajo.12014","type":"journal-article","created":{"date-parts":[[2012,11,1]],"date-time":"2012-11-01T05:56:37Z","timestamp":1351749397000},"page":"3-8","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["The case for retaining severe perineal tears as an indicator of the quality of obstetric care"],"prefix":"10.1111","volume":"53","author":[{"given":"Peter A.","family":"Baghurst","sequence":"first","affiliation":[{"name":"Public Health Research Unit Women's and Children's Hospital, Women's and Children's Health Network Adelaide South Australia Australia"},{"name":"Discipline of Paediatrics, Faculty of Health Sciences University of Adelaide Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,11]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2011.03210.x"},{"key":"e_1_2_6_3_1","volume-title":"Benchmarking Maternity Care 2006\u20132008","author":"Baghurst P","year":"2009"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199312233292601"},{"key":"e_1_2_6_5_1","volume-title":"Towards National Indicators of Safety and Quality in Healthcare","author":"Australian Institute of Health and Welfare","year":"2009"},{"key":"e_1_2_6_6_1","first-page":"131","volume-title":"Measures of Patient Safety Based on Hospital Administrative Data \u2013 The Patient Safety Indicators","author":"McDonald K","year":"2002"},{"key":"e_1_2_6_7_1","unstructured":"Royal College of Obstetrics and Gynaecology.Good Practice No. 7: Maternity Dashboard: Clinical Performance and Governance Score Card. 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