Aim of the study: The aim of this study was to measure the effects of a specific technique used when assisting vaginal delivery and intended to decrease anal sphincter ruptures. After measuring the effects, the direct costs of a rupture were calculated and finally the cost impact of the intervention was evaluated. Data and model: Data from deliveries before the intervention, from 2004, and after the intervention, from 2008, were used and a pre-test – post-test evaluation design was applied. The dependent variable was the presence or absence of a rupture and because the variable is binary a logit model was used. The independent variables consisted of twelve different factors considered to affect the number of ruptures. When only accounting for ruptures alone 123 of 2900 deliveries resulted in a sphincter ruptures which equals 4.24% of the total amount of deliveries. Results: When not controlling for any of the independent variables, the risk of getting a rupture decreased by 3.8 percentage points when using the method while assisting a delivery. On the other hand, when controlling for all of the independent variables and the use of the method, the risk of getting a rupture decreased by 2.5 percentage points, from 4.24% to 1.74%. Two different models were tested, one with the variable weeks and one without the same variable, due to the presence of correlation in the model. The total cost of ruptures for a year was calculated as $84,429,254 without the implementation of the method and $34,647,854 with the implementation. Total cost savings for society with the implementation of the method would then be $49,677,045. Conclusions: Implementation of the method is highly recommendable for both society and the women involved. Not only does the number of ruptures decrease due to the method but also the costs for society decreases dramatically.

Background: Sphincter injury is serious complication in connection to vaginal childbirth. Desire to avoid vaginal birth again is seen in women who previously suffered from a sphincter injury. Objective: To identify and evaluate obstetric guidelines in Sweden regarding sphincter injury in relation to childbirth Method: Content analysis with a combination of a deductive and inductive approach. Results: The most frequently occurring risk factors and prevention with help of perineal protection were described in the guidelines. The physician made diagnosis and repaired the sphincter injury at the theatre.  Complications such as coital pain and anal incontinence were described in the guidelines. Paracetamol and diclofenac was most common analgesic regimen given for pain. Prophylaxis such as antibiotic treatment and laxative were common. Information given to women was described. Follow-up by physician, midwife and physiotherapist was recommended after four weeks to six months. For future birth a cesarean section was recommended. Conclusion: The guidelines were constructed in the same way and had to a large extent similar content. The authors of the present work recommend a national guideline. / Bakgrund: Sfinkterskada är en allvarlig komplikation i samband med vaginal förlossning. Önskan om att undvika vaginal förlossning igen ses hos kvinnor som tidigare drabbats av sfinkterskada. Syfte: Syftet med studien var att ta reda på om det fanns riktlinjer gällande sfinkterskada i samband med förlossning vid Sveriges förlossningskliniker samt sammanställa och granska innehållet i riktlinjerna. Metod: Innehållsanalys med en kombination av deduktiv och induktiv ansats. Resultat: Av de 39 kliniker som svarade hade 31 riktlinjer gällande sfinkterskada. I riktlinjerna beskrevs vanligast förekommande riskfaktorer samt prevention med hjälp av perinealskydd. Läkaren ställde diagnos och utförde reparation av sfinkterskadan på operationsavdelningen. Komplikationer som samlagssmärta och anal inkontinens fanns beskrivet i riktlinjerna. Paracetamol och diklofenak var den vanligast förekommande smärtlindringen. Profylax som antibiotikabehandling och laxantia gavs av de flesta förlossningskliniker. Information till den nyförlösta kvinnan beskrevs. Uppföljning hos läkare, barnmorska och sjukgymnast rekommenderades efter fyra veckor till sex månader. Vid kommande graviditet och förlossning föredrogs kejsarsnitt. Slutsats: Riktlinjerna var uppbyggda på samma sätt och hade till stor del liknande innehåll. Författarna till föreliggande fördjupningsarbete efterfrågar en nationell riktlinje.