Management of third degree perineal tear and choice of mode of delivery in subsequent pregnancies.

This study evaluates the management of third/fourth-degree obstetric tears and choice of mode of delivery in subsequent pregnancies amongst obstetricians practising in Ireland. Of the 185 obstetricians who were sent questionnaires 133 replied, giving a response rate of 72%. The consultant obstetricians were significantly more likely to suture third-degree tears in the labour ward than the non-consultant counterpart, P=0.04. There was no statistically significant difference between the two groups on the repair technique, P=0.397. The non-consultant obstetricians were significantly more likely to prescribe laxatives and diclofenac (Volterol) after repair of third/fourth-degree tears. There were significant differences between the two groups of obstetricians in terms of choice of mode of delivery in subsequent pregnancies, and the appropriate person to conduct labour, P=0.044 and 0.017, respectively. Instrumental intervention and use of episiotomies were similar in the two groups. Our study also shows that Fellows and Members of the Royal College of Obstetricians and Gynaecologists (RCOG) are not adhering to the guidelines on the repair of third/fourth-degree tears. We conclude that there is variation in the management of third-degree obstetric tears and choice of mode of delivery in subsequent pregnancies among the obstetricians.