ACOG Committee Opinion No. 647: Limitations of Perineal Lacerations as an Obstetric Quality Measure.

Perineal lacerations are a common occurrence with vaginal delivery. Although perineal lacerations are tracked easily from coding data, there are a variety of problems with using rates of such tears as a quality measure. The rate of severe perineal lacerations should not be used as a measure of obstetric quality for the following three reasons: 1) third-degree and fourth-degree perineal lacerations may not be defined uniformly; 2) severe perineal lacerations are associated strongly with nonmodifiable risk factors; and 3) diminishing the use of operative vaginal delivery, in an effort to decrease severe perineal lacerations, likely would result in an increased rate of cesarean delivery. Measuring the rate of episiotomy with unassisted vaginal deliveries is an alternative candidate for quality measurement, but it requires validation before widespread implementation.