"Identifying Information: Name","Obstetric Trauma (With Instrument)"
"Identifying Information: Short/Other Names","Obstetric Trauma: Vaginal Delivery With Instrument"
"Identifying Information: Description","This indicator measures the rate of obstetric trauma (lacerations that are third degree or greater in severity) for instrument-assisted vaginal deliveries.

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 lacerations that are third degree and greater in severity, may result in longer lengths of stay for mothers, as well as chronic complications such as fecal incontinence, dyspareunia, perineal pain and other pelvic floor disorders.

Risk factors for obstetric trauma include prolonged pregnancy, long labour, malposition and maternal age. One of the most significant and potentially modifiable risk factors for obstetric trauma is the use of instruments during vaginal delivery. By ensuring appropriate training and adherence with best practice guidelines during instrument-assisted deliveries, hospitals can potentially reduce the risk of obstetric trauma.

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","A lower rate is more 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
"Result Updates: Indicator Results","Web Tool:
Your Health System: In Depth
PDF:
Accessing Indicator Results on Your Health System: In Depth (PDF)"
"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 the rate of obstetric traumas per 100 instrument-assisted 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 with instrument-assisted delivery"
"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)
	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)"
"Denominator: Exclusions:","Newborn, stillbirth or cadaveric donor records (Admission Category = N, R or S)
	Records with invalid discharge date
	Records with invalid age
	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). Updated August 14, 2007. Accessed February 12, 2014.

OECD. Health at a Glance 2013: OECD Indicators. Published November 21, 2013. Accessed February 12, 2014.

Groutz A, Hasson J, Wengier A, et al. Third- and fourth-degree perineal tears: Prevalence and risk factors in the third millennium. Am J Obstet Gynecol. 2011;204(4): 347e1-347e4.

Handa VL, Blomquist JL, McDermott KC et al. Pelvic floor disorders after childbirth: Effect of episiotomy, perineal laceration, and operative birth. Obstet Gynecol. 2012;119(2 Pt 1):233-239."