"Identifying Information: Name","Obstetric Trauma: Vaginal Delivery Without Instrument"
"Identifying Information: Short/Other Names","Obstetric Trauma (Without Instrument)"
"Identifying Information: Description","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)."
"Background, Interpretation and Benchmarks: Rationale","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."
"Background, Interpretation and Benchmarks: Interpretation","Lower rates are desirable."
"Background, Interpretation and Benchmarks: HSP Framework Dimension",Safe
"Background, Interpretation and Benchmarks: Areas of Need","Getting Better"
"Background, Interpretation and Benchmarks: Targets/Benchmarks","Not applicable"
"Available Data Years","2018
 to 2022"
"Available Data Years: Type of Year",Fiscal
"Availability of Results: Geographic Coverage","All provinces/territories"
"Reporting Level/Disaggregation",National
"Reporting Level/Disaggregation: Other reporting level/disaggregation","Peer Group"
"Result Updates: Indicator Results","Web Tool:

Your Health System: Insight "
"Update Frequency","Every year"
"Result Updates: Latest Results Update Date","November 2023"
"Result Updates: Updates","Not applicable"
"Indicator Calculation: Description","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"
"Indicator Calculation: Type of Measurement",Rate
"Indicator Calculation: Number or Rate","per 100"
"Denominator: Description:","Vaginal delivery discharges without the use of an instrument"
"Denominator: Inclusions:","Admission to an acute care institution (Facility Type Code = 1)
	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)"
"Denominator: Exclusions:","Newborn, stillbirth or cadaveric donor records (Admission Category Code = N, R or S)
	Records with invalid discharge date
	Records with invalid age
	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)
	Records with unknown or invalid (>45 completed weeks) gestational age
	Caesarean sections (CCI code: 5.MD.60.^^)
	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
	2018–2019 data onward: Medical assistance in dying (MAID) (Discharge Disposition Code = 73)"
"Numerator: Description:","Cases within the denominator with obstetric trauma"
"Numerator: Inclusions:","Cases within the denominator with at least one obstetric trauma (any of the following conditions or interventions):


	Third-degree perineal laceration during delivery, delivered, with or without mention of antepartum condition (ICD-10-CA: O70.201 [prior to 2018–2019 data], O70.211, O70.221, O70.231, O70.281, O70.291) 
	Fourth-degree perineal laceration during delivery, delivered, with or without mention of antepartum condition (ICD-10-CA: O70.301)
	Obstetric laceration of cervix, delivered, with or without mention of antepartum condition (ICD-10-CA: O71.301)
	Obstetric high vaginal laceration alone, delivered, with or without mention of antepartum condition (ICD-10-CA: O71.401)
	Other obstetric injury to pelvic organs, delivered, with or without mention of antepartum condition (ICD-10-CA: O71.501)
	Other rupture of uterus during labour, delivered, with or without mention of antepartum condition (ICD-10-CA: O71.181)
	Obstetric damage to pelvic joints and ligaments, delivered, with or without mention of antepartum condition (ICD-10-CA: O71.601)
	Surgical repair, postpartum, of obstetric laceration:
	
		Of corpus uteri (CCI code: 5.PC.80.JH)
		Of current obstetric laceration of cervix occurring at vaginal delivery (CCI code: 5.PC.80.JJ)
		Of current obstetric laceration of bladder and urethra (CCI code: 5.PC.80.JR)
		Of current obstetric laceration of rectum and sphincter ani (CCI code: 5.PC.80.JQ)
		Of current obstetric high vaginal laceration (CCI code: 5.PC.80.JU)
		Of current obstetric laceration of broad ligament(s) of uterus (CCI code: 5.PC.80.JL)"
"Method of Adjustment","Logistic regression"
"Adjustment Applied: Covariates used in risk adjustment:","For a detailed list of covariates used in the model, please refer to the Model Specification (PDF) document."
"Indicator Calculation: Geographic Assignment","Place of service"
"Data Sources",DAD
"Quality Statement: Caveats and Limitations","Not applicable"
"Quality Statement: Trending Issues","Not applicable"
"Quality Statement: Comments","Indicator results are also available in


	Your Health System: Insight, updated monthly"
References,"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."