{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T15:47:35Z","timestamp":1791474455094,"version":"4.3.4"},"reference-count":30,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2022,5,11]],"date-time":"2022-05-11T00:00:00Z","timestamp":1652227200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012446","name":"Akershus Universitetssykehus","doi-asserted-by":"publisher","award":["Department of Obstetrics and Gynecology"],"award-info":[{"award-number":["Department of Obstetrics and Gynecology"]}],"id":[{"id":"10.13039\/501100012446","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006095","name":"Helse S\u00f8r-\u00d8st RHF","doi-asserted-by":"publisher","award":["Reference 270926"],"award-info":[{"award-number":["Reference 270926"]}],"id":[{"id":"10.13039\/501100006095","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Second\u2010degree perineal tears can vary widely as to the extent of trauma, which may be relevant for women's pelvic floor health postpartum. However, the short\u2010 and long\u2010term consequences of second\u2010degree perineal tears are poorly understood, likely due to the lack of a detailed classification system. Such a classification system for second\u2010degree tears has been suggested but the inter\u2010rater agreement has not yet been assessed. The aim of this study was to assess the inter\u2010rater agreement of the already established classification system for perineal tears recommended by the Royal College of Obstetricians and Gynaecologists (RCOG classification) among midwives. Further, we aimed to assess the inter\u2010rater agreement of a classification system that provides three sub\u2010categories for second\u2010degree perineal tears.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>This was an inter\u2010rater agreement study, conducted at Akershus University Hospital in Norway from 31 August to 29 November 2020. All midwives working in the delivery ward participated in the study. Midwives classified the integrity of the perineum of all women delivering vaginally within the study period. During the first month of the study, tears were classified by two midwives who were blinded to each other's findings, and the agreement of the RCOG classification was assessed. The following month, the detailed classification system was introduced to the midwifery staff. The last month, perineal tears were classified by two midwives using the detailed classification system, and the agreement was assessed. Inter\u2010rater agreement was measured using Fleiss multirater kappa (<jats:italic>k<\/jats:italic>) and Kendall's coefficient of concordance (KCC<jats:sub>w<\/jats:sub>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The inter\u2010rater agreement for the RCOG classification was good to very good, with <jats:italic>k<\/jats:italic>\u00a0=\u00a00.705 (95% confidence interval [CI] 0.62\u20130.79, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), KCC<jats:sub>w<\/jats:sub>\u00a0=\u00a00.928 (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). The inter\u2010rater agreement for the detailed classification system was good to very good, with <jats:italic>k<\/jats:italic>\u00a0=\u00a00.748 (95% CI 0.67\u20130.83, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), KCC<jats:sub>w<\/jats:sub>\u00a0=\u00a00.956 (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The inter\u2010rater agreement among midwives using both the RCOG classification and the detailed classification system among midwives was good to very good. The detailed classification system provides additional information about the extent of tissue trauma in second\u2010degree tears, warranted for future research on women's pelvic floor health postpartum.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14369","type":"journal-article","created":{"date-parts":[[2022,5,12]],"date-time":"2022-05-12T05:24:32Z","timestamp":1652333072000},"page":"880-888","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Detailed classification of second\u2010degree perineal tears in the delivery ward: an inter\u2010rater agreement study"],"prefix":"10.1111","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0983-8603","authenticated-orcid":false,"given":"Marthe Dalevoll","family":"Macedo","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Akershus University Hospital  L\u00f8renskog Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Ellstr\u00f6m Engh","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Akershus University Hospital  L\u00f8renskog Norway"},{"name":"Division Akershus University Hospital, Faculty of Medicine University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franziska","family":"Siafarikas","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Akershus University Hospital  L\u00f8renskog Norway"},{"name":"Division Akershus University Hospital, Faculty of Medicine University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,5,11]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.0001-6349.2001.10182.x"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.02.064"},{"key":"e_1_2_10_4_1","unstructured":"Federative Committee on Anatomical Terminology Terminologia Anatomica;1998 Updated: 29.01.2013. 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