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Australian Institute of Health and Welfare (2022) National Core Maternity Indicators, AIHW, Australian Government, accessed 10 December 2022.
Australian Institute of Health and Welfare. (2022). National Core Maternity Indicators. Retrieved from https://pp.aihw.gov.au/reports/mothers-babies/national-core-maternity-indicators
National Core Maternity Indicators. Australian Institute of Health and Welfare, 28 September 2022, https://pp.aihw.gov.au/reports/mothers-babies/national-core-maternity-indicators
Australian Institute of Health and Welfare. National Core Maternity Indicators [Internet]. Canberra: Australian Institute of Health and Welfare, 2022 [cited 2022 Dec. 10]. Available from: https://pp.aihw.gov.au/reports/mothers-babies/national-core-maternity-indicators
Australian Institute of Health and Welfare (AIHW) 2022, National Core Maternity Indicators, viewed 10 December 2022, https://pp.aihw.gov.au/reports/mothers-babies/national-core-maternity-indicators
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A perineal tear is the laceration of the skin and tissues that separate the vagina from the anus. Third or fourth degree tears are classified as severe trauma to the perineum and can occur spontaneously or as a result of obstetric intervention during vaginal birth. For more information, see Clinical commentary.
This indicator looks at the proportion of third and fourth degree tears among all women who gave birth vaginally, and among all vaginal first births.
The interactive data visualisation below presents data on third and fourth degree tears for all vaginal births and all vaginal first births by selected maternal characteristics. Click the Data tables button to view the data between 2013 and 2020 and use the radio buttons to see how each characteristic has changed during this time.
Third and fourth degree tears for all vaginal first births, by State/territory of birth and all Australia, 2013 to 2020.
This chart shows the proportion of third and fourth degree tears in mothers for all vaginal first births, by state/territory of birth, 2013 to 2020. Data can be viewed for each state/territory of birth, and for all Australia. The proportion of third and fourth degree tears for all vaginal first births, for all Australia, has fluctuated around 5% with 5.2% in 2013 and 4.8% in 2020. The chart also includes an option to display data for third and fourth degree tears for all vaginal births. The proportion of third and fourth degree tears for all vaginal births, in Australia, has remained steady with 3.0% in 2013 and 2.9% in 2020.
Severe perineal trauma is defined as a third degree tear, which involves injury to the perineum which extends to the anal sphincter muscles; or a fourth degree tear, which involves injury to the perineum involving the external and internal sphincter and the anorectal epithelium (RCOG 2015). Severe trauma to the perineum can occur spontaneously or due to obstetric intervention during vaginal birth.
Severe perineal trauma is associated with maternal morbidity such as perineal pain, incontinence and subsequent difficult or painful sexual intercourse, and rarely, recto-vaginal fistula (RCOG 2015; ACSQHC 2021). The significant psychological effects of severe perineal trauma are under-researched but likely to be significant for many women in this situation (Priddis et al. 2013).
Risk factors during the antenatal period associated with an increased incidence of severe perineal trauma include nulliparity, young maternal age, ethnicity and poor nutritional status, high fetal weight, as well as previous experience of perineal tear (Dahlen et al. 2013). Intrapartum risk factors include fetal malpresentation (for example occipito-posterior position), episiotomy (especially midline), instrumental vaginal birth, prolonged second stage of labour, birth position and shoulder dystocia (Eskandar & Shet 2009; Hartman et al. 2005; Kudish et al. 2008; O’Mahony et al. 2010).
Excel source data tables are available from the Data tab.
For more information refer to Specifications and notes for analysis in the technical notes.
ACSQHC (Australian commission on Safety and Quality in Health Care) (2021). Third and fourth degree perineal tears clinical care standard (PDF). Viewed 17 August 2022.
Dahlen H, Proddis H, Schmied V, Sneddon A, Kettle C, Brown C & Thornton C (2013). Trends and risk factors for severe perineal trauma during childbirth in New South Wales between 2000 and 2008: a population-based data study. British Medical Journal Open 3(5): e002824.
Eskandar O & Shet D (2009). Risk factors for 3rd and 4th degree perineal tear. Journal of Obstetrics and Gynaecology 29:119–22.
Hartman K, Viswanathan M, Palmieri R, Gartlehner G, Thorp J & Lohr KN (2005). Outcomes of routine episiotomy: a systematic review. JAMA 293:2141–8.
Kudish B, Sokol RJ & Kruger M (2008). Trends in major modifiable risk factors for severe perineal trauma, 1996–2006. International Journal of Gynaecology and Obstetrics 102:165–70.
O’Mahony F, Hofmeyr GJ & Menon V (2010). Choice of instruments for assisted vaginal delivery. Cochrane Database Systematic Review 11:CD005455.
Priddis H, Dahlen HG & Schmied V (2013). Women’s experiences following severe perineal trauma: a meta-ethnographic synthesis. Journal of Advanced Nursing 64:748–59.
RCOG (The Royal College of Obstetricians and Gynaecologists) (2015). The management of Third- and Fourth-degree Perineal Tears: Green top guideline no. 29 (PDF). Viewed 6 October 2021.
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