Obstetric Trauma: Vaginal Delivery Without Instrument
Lower rates are desirable.
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
Vaginal delivery discharges without the use of an instrument
Cases within the denominator with obstetric trauma
Methodology
Name
Obstetric Trauma: Vaginal Delivery Without Instrument
Short/Other Names
Obstetric Trauma (Without Instrument)
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).
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.
Interpretation
Lower rates are desirable.
HSP Framework Dimension
ºìÁì½í¹Ï±¨ system outputs: Safe
Areas of Need
Getting Better
Targets/Benchmarks
Not applicable
Available Data Years
to (fiscal years)
Geographic Coverage
- All provinces/territories
Reporting Level/Disaggregation
- National
- Province/Territory
- Region
- Facility
- Peer Group
Indicator Results
Web Tool:
Update Frequency
Every year
Latest Results Update Date
Updates
Not applicable
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
Type of Measurement
Rate - per 100
Denominator
Description:
Vaginal delivery discharges without the use of an instrument
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)
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
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.
Geographic Assignment
Place of service
Data Sources
- DAD
- HMDB
Caveats and Limitations
Not applicable
Trending Issues
Not applicable
References
Groutz A, Hasson J, Wengier A, et al. . American Journal of Obstetrics & Gynecology. 2011.
Handa VL, Blomquist JL, McDermott KC, et al. . Obstetrics & Gynecology. 2012.
Organisation for Economic Co-operation and Development. . 2023.
How to cite:
Canadian Institute for ºìÁì½í¹Ï±¨ Information. Obstetric Trauma: Vaginal Delivery Without Instrument . Accessed April 4, 2025.
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Comments
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