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Davies-Tuck M, Biro MA, Mockler J, Stewart L, Wallace EM, East C. Maternal Asian ethnicity and the risk of anal sphincter injury. Acta Obstet Gynecol Scand 2015; 94:308-15. [DOI: 10.1111/aogs.12557] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 12/05/2014] [Indexed: 12/25/2022]
Affiliation(s)
- Miranda Davies-Tuck
- The Ritchie Centre; MIMR-PHI Institute; Monash University; Clayton Victoria Australia
- Department of Obstetrics and Gynaecology; Monash University; Clayton Victoria Australia
| | - Mary-Anne Biro
- School of Nursing and Midwifery; Monash University; Clayton Victoria Australia
| | - Joanne Mockler
- The Ritchie Centre; MIMR-PHI Institute; Monash University; Clayton Victoria Australia
- Department of Obstetrics and Gynaecology; Monash University; Clayton Victoria Australia
- Monash Health; Monash Medical Centre; Clayton Victoria Australia
| | - Lynne Stewart
- Monash Health; Monash Medical Centre; Clayton Victoria Australia
| | - Euan M Wallace
- The Ritchie Centre; MIMR-PHI Institute; Monash University; Clayton Victoria Australia
- Department of Obstetrics and Gynaecology; Monash University; Clayton Victoria Australia
- Monash Health; Monash Medical Centre; Clayton Victoria Australia
| | - Christine East
- School of Nursing and Midwifery; Monash University; Clayton Victoria Australia
- Monash Health; Monash Medical Centre; Clayton Victoria Australia
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East CE, Lau R, Biro MA. Midwives׳ and doctors׳ perceptions of their preparation for and practice in managing the perineum in the second stage of labour: A cross-sectional survey. Midwifery 2015; 31:122-31. [DOI: 10.1016/j.midw.2014.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 05/07/2014] [Accepted: 07/03/2014] [Indexed: 01/07/2023]
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King TL, Pinger W. Evidence‐Based Practice for Intrapartum Care: The Pearls of Midwifery. J Midwifery Womens Health 2014; 59:572-585. [DOI: 10.1111/jmwh.12261] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Begley CM. Intervention or interference? The need for expectant care throughout normal labour. SEXUAL & REPRODUCTIVE HEALTHCARE 2014; 5:160-4. [DOI: 10.1016/j.srhc.2014.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 09/22/2014] [Accepted: 10/11/2014] [Indexed: 11/30/2022]
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Rezaei R, Saatsaz S, Chan YH, Nia HS. A comparison of the "hands-off" and "hands-on" methods to reduce perineal lacerations: a randomised clinical trial. J Obstet Gynaecol India 2014; 64:425-9. [PMID: 25489147 PMCID: PMC4257914 DOI: 10.1007/s13224-014-0535-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 03/08/2014] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The objective of the current study was to compare the "Hands-off" and "Hands-on" methods to reduce perineal lacerations. METHOD We conducted a randomized controlled trial to compare the effectiveness of two techniques for perineum protection during spontaneous delivery. Study participants included 600 nulliparous expectant mothers, who were divided equally between the "hands off" and "hands on" groups (n_300 per group). FINDINGS A total of 147 (49 %) women in the "Hands-on" and 143 women (47.7 %) in the "Hand -off" groups encountered perineal trauma (p = 0.74). In the "Hands-on" group, 8 women (2.7 %) experienced a third degree trauma compared with (0.3 %) that in the "Hands-off" method (p = 0.1). Episiotomy was performed on 38 women (12.7 %) from the "Hands-on" and 17 (5.7 %) women from the "Hands-off" (p = 0.003) groups. In addition, 28 women (9.3 %) from the "Hands-on" group and 47 women (15.7 %) from the "Hands-off" group experienced periurethral tears (p = 0.01) that did not need mending. CONCLUSION Application of the "Hands-off" method for vaginal delivery has a positive effect on the mother's health because of the reduction of Episiotomy and third degree tearing. Therefore, we conclude that the "Hands-off" method offers a safer alternative for perineal control during labor.
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Affiliation(s)
- Rozita Rezaei
- />Faculty of Nursing and Midwifery of Amol, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sussan Saatsaz
- />Faculty of Nursing and Midwifery of Amol, Mazandaran University of Medical Sciences, Sari, Iran
| | - Yiong Huak Chan
- />Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore
| | - Hamid Sharif Nia
- />Faculty of Nursing and Midwifery of Amol, Mazandaran University of Medical Sciences, Sari, Iran
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Identification of women at high risk for severe perineal lacerations. Eur J Obstet Gynecol Reprod Biol 2014; 182:11-5. [DOI: 10.1016/j.ejogrb.2014.08.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 08/14/2014] [Accepted: 08/21/2014] [Indexed: 01/13/2023]
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Renfrew MJ, McFadden A, Bastos MH, Campbell J, Channon AA, Cheung NF, Silva DRAD, Downe S, Kennedy HP, Malata A, McCormick F, Wick L, Declercq E. Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care. Lancet 2014; 384:1129-45. [PMID: 24965816 DOI: 10.1016/s0140-6736(14)60789-3] [Citation(s) in RCA: 723] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In this first paper in a series of four papers on midwifery, we aimed to examine, comprehensively and systematically, the contribution midwifery can make to the quality of care of women and infants globally, and the role of midwives and others in providing midwifery care. Drawing on international definitions and current practice, we mapped the scope of midwifery. We then developed a framework for quality maternal and newborn care using a mixed-methods approach including synthesis of findings from systematic reviews of women's views and experiences, effective practices, and maternal and newborn care providers. The framework differentiates between what care is provided and how and by whom it is provided, and describes the care and services that childbearing women and newborn infants need in all settings. We identified more than 50 short-term, medium-term, and long-term outcomes that could be improved by care within the scope of midwifery; reduced maternal and neonatal mortality and morbidity, reduced stillbirth and preterm birth, decreased number of unnecessary interventions, and improved psychosocial and public health outcomes. Midwifery was associated with more efficient use of resources and improved outcomes when provided by midwives who were educated, trained, licensed, and regulated. Our findings support a system-level shift from maternal and newborn care focused on identification and treatment of pathology for the minority to skilled care for all. This change includes preventive and supportive care that works to strengthen women's capabilities in the context of respectful relationships, is tailored to their needs, focuses on promotion of normal reproductive processes, and in which first-line management of complications and accessible emergency treatment are provided when needed. Midwifery is pivotal to this approach, which requires effective interdisciplinary teamwork and integration across facility and community settings. Future planning for maternal and newborn care systems can benefit from using the quality framework in planning workforce development and resource allocation.
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Affiliation(s)
- Mary J Renfrew
- Mother and Infant Research Unit, School of Nursing and Midwifery, College of Medicine, Dentistry and Nursing, University of Dundee, Dundee, UK.
| | - Alison McFadden
- Mother and Infant Research Unit, School of Nursing and Midwifery, College of Medicine, Dentistry and Nursing, University of Dundee, Dundee, UK
| | | | - James Campbell
- Instituto de Cooperación Social Integrare, Barcelona, Spain
| | - Andrew Amos Channon
- Division of Social Statistics and Demography, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Ngai Fen Cheung
- Midwifery Expert Committee of the Maternal and Child Health Association of China, Beijing, China
| | | | - Soo Downe
- School of Health, University of Central Lancashire, Preston, Lancashire, UK
| | | | - Address Malata
- Kamuzu College of Nursing University of Malawi, Lilongwe, Malawi
| | - Felicia McCormick
- Department of Health Sciences, University of York, Heslington West, York, UK
| | - Laura Wick
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Eugene Declercq
- Community Health Sciences, Boston University School of Public Health, Boston, MD, USA
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Edqvist M, Lindgren H, Lundgren I. Midwives' lived experience of a birth where the woman suffers an obstetric anal sphincter injury--a phenomenological study. BMC Pregnancy Childbirth 2014; 14:258. [PMID: 25086994 PMCID: PMC4129100 DOI: 10.1186/1471-2393-14-258] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/24/2014] [Indexed: 11/18/2022] Open
Abstract
Background The occurrence of obstetric anal sphincter injuries (OASIS) has increased in most high-income countries during the past twenty years. The consequences of these injuries can be devastating for women and have an impact on their daily life and quality of health. The aim of this study was to obtain a deeper understanding of midwives’ lived experiences of attending a birth in which the woman gets an obstetric anal sphincter injury. Methods A qualitative study using phenomenological lifeworld research design. The data were collected through in-depth interviews with 13 midwives. Results The essential meaning of the phenomenon was expressed as a deadlock difficult to resolve between a perceived truth among midwives that a skilled midwife can prevent severe perineal trauma and at the same time a coexisting more complex belief. The more complex belief is that sphincter injuries cannot always be avoided. The midwives tried to cope with their feelings of guilt and wanted to find reasons why the injury occurred. A fear of being exposed and judged by others as severely as they judged themselves hindered the midwives from sharing their experience. Ultimately the midwives accepted that the injury had occurred and moved on without any definite answers. Conclusions Being caught between an accepted truth and a more complex belief evoked various emotions among the midwives. Feelings of guilt, shame and the midwife’s own suspicion that she is not being professionally competent were not always easy to share. This study shows the importance of creating a safe working environment in which midwives can reflect on and share their experiences to continue to develop professionally. Further research is needed to implement and evaluate the effect of reflective practices in relation to midwifery care and whether this could benefit women in childbirth.
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Affiliation(s)
- Malin Edqvist
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Arvid Vallgrens backe hus 1, Box 457, 405 30 Gothenburg, Sweden.
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The effect of primary delivery of the anterior compared with the posterior shoulder on perineal trauma: a study protocol for a randomized controlled trial. Trials 2014; 15:291. [PMID: 25047001 PMCID: PMC4223378 DOI: 10.1186/1745-6215-15-291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 07/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 85% of vaginal deliveries are accompanied by perineal trauma. The objective of this trial is to compare the incidence and degree of perineal trauma after primary delivery of the anterior compared with the posterior shoulder during vaginal birth. The hypothesis is that primary delivery of the posterior shoulder reduces the rate and degree of perineal trauma. METHODS/DESIGN This is a single-centre, randomized controlled trial, with computer-generated randomization in a 1:1 allocation ratio. Women planning their first vaginal delivery (n = 650) are randomized to primary delivery of either the anterior or posterior shoulder. The primary outcome is any perineal trauma. Additional outcomes are the perineal injury subtypes, postpartum bleeding, umbilical artery pH, Apgar score at 5 minutes and any neonatal birth trauma. Perineal trauma is assessed by a midwife or doctor blinded to the method of shoulder delivery. All midwives are trained in the two methods of shoulder delivery and in the grading of perineal tears. The trial is being undertaken at a Danish community hospital with 1,600 yearly deliveries. Data will be analyzed according to the intention-to-treat principle. Recruitment started in January 2013 and the trial is planned to proceed for 24 months. DISCUSSION Most delivery assistance techniques are based on tradition and heritage and lack objective evidence. This trial provides an example of how vaginal delivery techniques can be evaluated in a randomized controlled trial. The results of this trial will clarify the role that delivery of the shoulders has on perineal trauma and thereby provide knowledge to recommendations on birthing technique. TRIAL REGISTRATION ClinicalTrials.gov: NCT01937546.
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Priddis HS, Schmied V, Kettle C, Sneddon A, Dahlen HG. "A patchwork of services"--caring for women who sustain severe perineal trauma in New South Wales--from the perspective of women and midwives. BMC Pregnancy Childbirth 2014; 14:236. [PMID: 25034120 PMCID: PMC4223519 DOI: 10.1186/1471-2393-14-236] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 07/11/2014] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Current research into severe perineal trauma (3rd and 4th degree) focuses upon identification of risk factors, preventative practices and methods of repair, with little focus on women's experiences of, and interactions with, health professionals following severe perineal trauma (SPT). The aim of this study is to describe current health services provided to women in New South Wales (NSW) who have experienced SPT from the perspective of Clinical Midwifery Consultants (CMC) and women. METHODS This study used a descriptive qualitative design and reports on the findings of a component of a larger mixed methods study. Data were collected through a semi-structured discussion group using a variety of non-directive, open-ended questions leading CMCs of NSW. A survey was distributed prior to the discussion group to collect further information and enable a more comprehensive understanding of services provided. Data from individual interviews with twelve women who had experienced SPT during vaginal birth is used to provide greater insight into their interactions with, and ease of access to, health service providers in NSW. An integrative approach was undertaken in reporting the findings which involved comparing and analysing findings from the three sets of data. RESULTS One overarching theme was identified: A Patchwork of Policy and Process which identified that current health services operate in a 'patchwork' manner when caring for women who sustain SPT. They are characterised by lack of consistency in practice and standardisation of care. Within the overarching theme, four subthemes were identified: Falling through the gaps; Qualifications, skills and attitudes of health professionals; Caring for women who have sustained SPT; and Gold standard care: how would it look? CONCLUSION The findings from this study suggest that current health services in NSW represent a 'patchwork' of service provision for women who have sustained SPT. It appeared that women seek compassionate and supportive care based upon a clear exchange of information, and this should be considered when reflecting upon health service design. This study highlights the benefits of establishing multi-disciplinary collaborative specialist clinics to support women who experience SPT and associated morbidities, with the aim of providing comprehensive physiological and psychological support.
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Affiliation(s)
- Holly S Priddis
- School of Nursing and Midwifery, University of Western Sydney, Building EB, Parramatta Campus, Locked Bag 1797, Penrith South DC NSW 2751, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, University of Western Sydney, Building EB, Parramatta Campus, Locked Bag 1797, Penrith South DC NSW 2751, Australia
| | - Christine Kettle
- Staffordshire University, Blackheath Lane, Stafford, Staffordshire ST18 0AD, UK
| | - Anne Sneddon
- Obstetrics and Gynaecology Gold Coast, Griffith University, Gold Coast, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, University of Western Sydney, Building EB, Parramatta Campus, Locked Bag 1797, Penrith South DC NSW 2751, Australia
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Terré-Rull C, Beneit-Montesinos JV, Gol-Gómez R, Garriga-Comas N, Ferrer-Comalat A, Salgado-Poveda I. [Application of perineum heat therapy during partum to reduce injuries that require post-partum stitches]. ENFERMERIA CLINICA 2014; 24:241-7. [PMID: 24878363 DOI: 10.1016/j.enfcli.2014.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 02/21/2014] [Accepted: 03/30/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Evaluate the effectiveness of heat, moist or dry to the perineum during delivery in order to reduce injuries requiring perineal suturing after birth, and to assess its safety in relation to the adaptation of the newborn to extrauterine life. METHOD An open multicentre clinical trial directed from the School of Nursing at the University of Barcelona was carried out between 2009 and 2010 in 5 Catalan Hospitals. The sample consisted of 198 pregnant women subjected to the natural protocol for normal delivery assistance. The pregnant women were randomized to three study groups: moist heat (MHG), dry heat (DHG), and control (CG). Usual care of the perineum was performed during labour in all groups and MHG or GCS was also applied in the perineum in the intervention groups. The Apgar score in the newborn and perineum postpartum was then assessed. Statistical tests were performed using a 95% confidence interval. Statistical analyses were performed using the SPSS version 17. RESULTS Perinea that required no suturing: MHG 71% (47) versus CG 56% (37), OR: 1.803; (95% CI: 0.881-3.687); DHG 62% (41) versus CG 56% (37), OR:1.285 (95% CI: 0.641-2.577); MHG 71% (47) versus DHG 62% (41), OR:1.402 (95% CI: 0.680-2.890). MEAN: Apgar score 5', MHG: 9.91; DHG: 9.98, CG: 9.98. p=0.431. CONCLUSIONS The application of heat therapy to the perineum during labour did not significantly reduce perineal suturing after birth. However, better perineal results were observed with moist heat. Heat therapy does not alter neonatal outcomes measured by Apgar score.
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Affiliation(s)
- Carmen Terré-Rull
- Escuela de Enfermería, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España.
| | | | - Roser Gol-Gómez
- Institut Català de la Salut, ASSIR La Riera, Badalona, Barcelona, España
| | - Neus Garriga-Comas
- Hospital Sant Joan de Déu de la Fundación Althaia, Manresa, Barcelona, España
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Abstract
BACKGROUND Perineal hyaluronidase (HAase) injection was widely used to reduce the occurrence of perineal trauma, pain and need for episiotomy in the 1950s to 1960s. Reports suggested that the administration of HAase was a simple, low risk, low cost and effective way to decrease perineal trauma without adverse effects. OBJECTIVES The objective of this review was to assess the effectiveness and safety of perineal HAase injection for reducing spontaneous perineal trauma, episiotomy and perineal pain in vaginal deliveries. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2013), the International Clinical Trials Registry Platform (ICTRP) and the Networked Digital Library of Theses and Dissertations (both on 1 April 2013), and reference lists of retrieved studies. We also contacted relevant organisations. SELECTION CRITERIA Published and unpublished randomised and quasi-randomised controlled trials comparing perineal HAase injection with placebo injection or no intervention in vaginal deliveries. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion, extracted data and evaluated methodological quality. Data were checked for accuracy. MAIN RESULTS The search strategy identified six potentially eligible studies. Two studies were excluded. We included four randomised controlled trials that randomised a total of 599 women (data were available for 595 women).Two trials (283 women) compared the effects of perineal HAase injection during the second stage of labour with placebo injection and were at low risk of bias. Three trials (one three-armed trial was analysed twice) (373 women) compared the effects of perineal HAase injection during second stage of labour with no intervention and two out of the three trials were at high risk of bias. Data from four trials involving 599 women suggested that perineal HAase injection during second stage of labour had a lower incidence of perineal trauma (average risk ratio (RR) 0.69, 95% confidence interval (CI) 0.50 to 0.95,Tau² = 0.08, I² = 82% compared with women in the control group, but there was no clear evidence of a reduction in the incidence of episiotomy (average RR 0.74, 95% CI 0.43 to 1.29, Tau² = 0.17, I² = 66%), first and second degree perineal lacerations (average RR 0.54, 95% CI 0.38 to 1.33, Tau² = 0.30 , I² = 85%) and third and fourth degree perineal lacerations (RR 0.12, 95% CI 0.01 to 2.13). Data from two trials involving 283 women indicated that there was no clear evidence of a reduction in the incidence of perineal trauma (RR 0.90, 95% CI 0.77 to 1.06, Tau²=1.07, I² = 7%), episiotomy (RR 0.77, 95% CI 0.32 to 1.89, Tau² = 0.27, I² = 54%), first and second degree perineal lacerations (RR 1.08, 95% CI 0.83 to 1.40, Tau² = 1.11, I² = 10%) and third and fourth degree perineal lacerations (RR 0.12, 95% CI 0.01 to 2.13) with perineal HAase injection. Data from three trials involving 373 women suggested that perineal HAase injection during second stage of labour had a lower incidence of perineal trauma (RR 0.61, 95% CI 0.42 to 0.88, Tau² = 0.08, I² = 78%) compared with no intervention, but had no clear effect on in the incidence of episiotomy (RR 0.79, 95% CI 0.44 to 1.42, Tau² = 0.16, I² = 70%) and first and second degree perineal lacerations (RR 0.58, 95% CI 0.31 to 1.10, Tau² = 0.18, I² = 59%). No side effects were reported in the included trials.No included trials reported on perineal pain and other pre-specified secondary outcomes: perineal trauma requiring suturing; blood loss; dyspareunia; urinary incontinence; faecal incontinence; assisted delivery rate; women's satisfaction; Apgar score less than seven at five minutes and need for admission to special care baby unit. AUTHORS' CONCLUSIONS Perineal HAase injection during second stage of labour had a lower incidence of perineal trauma compared with control or no intervention, but there was no clear evidence of benefit compared with placebo injection. The difference in incidence of perineal trauma may probably be due to bias and confounding in the non-placebo controlled comparison, this result should be interpreted cautiously. The potential use of perineal HAase injection as a method to reduce perineal trauma were yet to be determined as there was no appropriate established dose for HAase, no evidence of follow up, and the number of high-quality trials and outcomes reported were too limited to draw conclusions on its effectiveness and safety. Further rigorous randomised controlled trials are required to evaluate the role of perineal HAase injection in vaginal deliveries.
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Affiliation(s)
- Fan Zhou
- West China Second University Hospital, Sichuan UniversityDepartment of Obstetrics and GynaecologyRenmin Nan RoadChengduSichuanChina610041
| | - Xiao Dong Wang
- West China Second University Hospital, Sichuan UniversityDepartment of Obstetrics and GynaecologyRenmin Nan RoadChengduSichuanChina610041
| | - Jing Li
- West China Hospital, Sichuan UniversityChinese Cochrane CentreNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Gui Qiong Huang
- West China Second University Hospital, Sichuan UniversityDepartment of Obstetrics and GynaecologyRenmin Nan RoadChengduSichuanChina610041
| | - Bing Xin Gao
- West China Second University Hospital, Sichuan UniversityDepartment of Obstetrics and GynaecologyRenmin Nan RoadChengduSichuanChina610041
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Zare O, Pasha H, Faramarzi M. Effect of perineal massage on the incidence of episiotomy and perineal laceration. Health (London) 2014. [DOI: 10.4236/health.2014.61003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Fretheim A, Odgaard-Jensen J, Røttingen JA, Reinar LM, Vangen S, Tanbo T. The impact of an intervention programme employing a hands-on technique to reduce the incidence of anal sphincter tears: interrupted time-series reanalysis. BMJ Open 2013; 3:e003355. [PMID: 24154515 PMCID: PMC3808759 DOI: 10.1136/bmjopen-2013-003355] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To re-evaluate previously published findings from an uncontrolled before-after evaluation of an intervention programme to reduce the incidence of anal sphincter tears. A key component of the programme was the use of a hands-on technique where the birth attendant presses the neonate's head during the final stage of delivery while simultaneously supporting the woman's perineum with the other hand. DESIGN Interrupted time-series analysis using segmented regression modelling. SETTING Obstetric departments of five Norwegian hospitals. PARTICIPANTS All women giving births vaginally in the study hospitals, 2002-2008. METHODS The main data source was the Medical Birth Registry of Norway. We estimated the change in incidence of anal sphincter tears before and after implementation of the intervention in the five intervention hospitals, taking into account the trends in incidence before and after implementation. MAIN OUTCOME MEASURES Incidence of anal sphincter tears and episiotomies. RESULTS There were 75 543 registered births at the five included hospitals. We found a 2% absolute reduction in incidence of anal sphincter tears associated with the hospital intervention programme, representing almost a halving in the number of women experiencing serious anal sphincter tears. This is a substantially smaller estimate than previously reported. However, it does represent a highly significant decrease in anal sphincter injuries. The programme was also associated with a significant increase in episiotomies. CONCLUSIONS The intervention programme was associated with a significant reduction in the incidence of obstetric anal sphincter tears. Still, the findings should be interpreted with caution as they seem to contradict the findings from randomised controlled studies of similar interventions.
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Affiliation(s)
- Atle Fretheim
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jan Odgaard-Jensen
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - John-Arne Røttingen
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Liv Merete Reinar
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Siri Vangen
- Woman and Children's Division, National Resource Centre for Women's Health, Oslo University Hospital, Oslo, Norway
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Tom Tanbo
- Woman and Children's Division, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Smith LA, Price N, Simonite V, Burns EE. Incidence of and risk factors for perineal trauma: a prospective observational study. BMC Pregnancy Childbirth 2013; 13:59. [PMID: 23497085 PMCID: PMC3599825 DOI: 10.1186/1471-2393-13-59] [Citation(s) in RCA: 193] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 02/20/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Our aim was to describe the range of perineal trauma in women with a singleton vaginal birth and estimate the effect of maternal and obstetric characteristics on the incidence of perineal tears. METHODS We conducted a prospective observational study on all women with a planned singleton vaginal delivery between May and September 2006 in one obstetric unit, three freestanding midwifery-led units and home settings in South East England. Data on maternal and obstetric characteristics were collected prospectively and analysed using univariable and multivariable logistic regression. The outcome measures were incidence of perineal trauma, type of perineal trauma and whether it was sutured or not. RESULTS The proportion of women with an intact perineum at delivery was 9.6% (125/1,302) in nulliparae, and 31.2% (453/1,452) in multiparae, with a higher incidence in the community (freestanding midwifery-led units and home settings). Multivariable analysis showed multiparity (OR 0.52; 95% CI: 0.30-0.90) was associated with reduced odds of obstetric anal sphincter injuries (OASIS), whilst forceps (OR 4.43; 95% CI: 2.02-9.71), longer duration of second stage of labour (OR 1.49; 95% CI: 1.13-1.98), and heavier birthweight (OR 1.001; 95% CI: 1.001-1.001), were associated with increased odds. Adjusted ORs for spontaneous perineal truama were: multiparity (OR 0.42; 95% CI: 0.32-0.56); hospital delivery (OR 1.48; 95% CI: 1.01-2.17); forceps delivery (OR 2.61; 95% CI: 1.22-5.56); longer duration of second stage labour (OR 1.45; 95% CI: 1.28-1.63); and heavier birthweight (OR 1.001; 95% CI: 1.000-1.001). CONCLUSIONS This large prospective study found no evidence for an association between many factors related to midwifery practice such as use of a birthing pool, digital perineal stretching in the second stage, hands off delivery technique, or maternal birth position with incidence of OASIS or spontaneous perineal trauma. We also found a low overall incidence of OASIS, and fewer second degree tears were sutured in the community than in the hospital settings. This study confirms previous findings of overall high incidence of perineal trauma following vaginal delivery, and a strong association between forceps delivery and perineal trauma.
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Affiliation(s)
- Lesley A Smith
- Department Social Work and Public Health, Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straws Lane, Marston, Oxford, OX3 0FL, UK
| | - Natalia Price
- Department of Obstetrics & Gynaecology, Women’s Centre, Oxford University Hospitals Trust, Oxford, OX3 9DU, UK
| | - Vanessa Simonite
- Department of Mechanical Engineering and Mathematical Sciences, Faculty of Technology, Design and Environment, Oxford Brookes University, Wheatley Campus, Wheatley, Oxford, OX33 1HX, UK
| | - Ethel E Burns
- Department Social Work and Public Health, Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straws Lane, Marston, Oxford, OX3 0FL, UK
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Low LK, Miller JM, Guo Y, Ashton-Miller JA, DeLancey JOL, Sampselle CM. Spontaneous pushing to prevent postpartum urinary incontinence: a randomized, controlled trial. Int Urogynecol J 2013; 24:453-60. [PMID: 22829349 PMCID: PMC3980478 DOI: 10.1007/s00192-012-1884-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 06/30/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The risk for urinary incontinence can be 2.6-fold greater in women after pregnancy and childbirth compared with their never-pregnant counterparts, with the incidence increasing with parity. We tested the hypothesis that the incidence of de novo postpartum urinary incontinence in primiparous women is reduced with the use of spontaneous pushing alone or in combination with perineal massage compared with women who experienced traditional directed pushing for second-stage management. METHODS This was a prospective clinical trial enrolling and randomizing 249 women into a four-group design: (1) routine care with coached or directed pushing, (2) spontaneous self-directed pushing, (3) prenatal perineal massage initiated in the third trimester, and (4) the combination of spontaneous pushing plus perineal massage. Self-report of incontinence was assessed using analysis of variance (ANOVA) and covariance (ANCOVA) models in 145 remaining women at 12 months postpartum using the Leakage Index, which is sensitive to minor leakage. RESULTS No statistical difference in the incidence of de novo postpartum incontinence was found based on method of pushing (spontaneous/directed) (P value = 0.57) or in combination with prenatal perineal massage (P value = 0.57). Fidelity to pushing treatment of type was assessed and between-groups crossover detected. CONCLUSIONS Spontaneous pushing did not reduce the incidence of postpartum incontinence experienced by women 1 year after their first birth due to high cross-over between randomization groups.
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Affiliation(s)
- Lisa Kane Low
- School of Nursing and Department of Women's Studies, University of Michigan, 400 North Ingalls Suite 3320, Ann Arbor, MI 48109, USA.
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Kataoka Y, Eto H, Iida M. Outcomes of independent midwifery attended births in birth centres and home births: a retrospective cohort study in Japan. Midwifery 2013; 29:965-72. [PMID: 23415360 DOI: 10.1016/j.midw.2012.12.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 06/13/2012] [Accepted: 12/17/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE the objective of this study was to describe and compare perinatal and neonatal outcomes of women who received care from independent midwives practicing home births and at birth centres in Tokyo. DESIGN a retrospective cohort study. SETTINGS birth centres and homes serviced by independent midwives in Tokyo. PARTICIPANTS of the 43 eligible independent midwives 19 (44%) (10 assisted birth at birth centres, nine assisted home birth) participated in the study. A total of 5477 women received care during their pregnancy and gave birth assisted by these midwives between 2001 and 2006. METHODS researchers conducted a retrospective chart review of women's individual data. Collected data included demographic characteristics, process of pregnancy and perinatal and neonatal outcomes. We also collected data about independent midwives and their practice. FINDINGS of the 5477 women, 83.9% gave birth at birth centres and 16.1% gave birth at home. The average age was 31.7 years old and the majority (70.6%) were multiparas. All women had vaginal spontaneous deliveries, with no vacuum, forceps or caesarean section interventions. No maternal fatalities were reported, nor were breech or multiple births. The average duration of the first and second stages of labour was 14.9 hours for primiparas and 6.2 hours for multiparas. Most women (97.1%) gave birth within 24 hours of membrane rupture. Maternal position during labour varied and family attended birth was common. The average blood loss was 371.3mL, while blood loss over 500mL was 22.6% and over 1000mL was 3.6%. Nearly 60% of women had intact perinea. There were few preterm births (0.6%) and post mature births (1.3%). Infant's average birth weight was 3126g and 0.5% were low-birthweight-infants, while 3.3% had macrosomia. Among primiparas, the birth centre group had more women experiencing an excess of 500mL blood loss compared to the home birth group (27.2% versus 17.6% respectively; RR 1.54; 95%CI 1.10 to 2.16). Multiparas delivering at birth centres were more likely to have a blood loss over 500mL (RR1.28; 95%CI 1.07 to 1.53) and over 1000mL (RR1.75; 95%CI 1.04 to 2.82) compared to women birthing at home. CONCLUSION our results for birth outcomes with independent midwives at birth centres and home births in Japan indicated a high degree of safety and evidence-based practice. This study had some limitations because of its incomplete data and low response rate. However, this is one of the few studies that reported outcomes of Japanese independent midwives and the safety of their practice. A birth registry system would provide us with more accurate and complete information of all childbirths with which to evaluate the safety of independent Japanese midwives.
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Affiliation(s)
- Yaeko Kataoka
- St. Luke's College of Nursing, 10-1 Akashi-cho Chuo-ku, Tokyo, Japan.
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Fretheim A. Fødselsrifter - vitenskapsteori og klinisk praksis. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2013; 133:652-4. [DOI: 10.4045/tidsskr.12.1460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Winkel AF, Lerner V, Zabar SR, Szyld D. A simple framework for assessing technical skills in a resident observed structured clinical examination (OSCE): vaginal laceration repair. JOURNAL OF SURGICAL EDUCATION 2013; 70:10-14. [PMID: 23337664 DOI: 10.1016/j.jsurg.2012.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 07/11/2012] [Accepted: 08/14/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Educators of trainees in procedure-based specialties need focused assessment tools that are valid, objective, and assess technical skills in a realistic context. A framework for hybrid assessment using standardized patient scenarios and bench skills testing might facilitate evaluation of competency. METHODS Seven PGY-1 obstetrics and gynecology residents participated in a hybrid assessment that used observed structured clinical examination (OSCE) by a standardized patient who had sustained a vaginal laceration during vaginal delivery. The residents elicited a history and counseled the patient, and then completed a laceration repair on a pelvic model. The residents were rated on their performance in the scenario, which included issues of cultural competency, rapport-building, patient counseling. The technical skills were videotaped and rated using a modified global assessment form by 2 faculty members on a 3-point scale from "not done" to "partly done" to "well-done." Residents also completed a subjective assessment of the station. RESULTS Mean technical performance of the residents on the technical skills was 55% "well-done," with a range of 20%-90%. The assessment identified 3 residents as below the mean, and 1 resident with areas of deficiency. Subjective assessment by the residents was that juggling the technical, cognitive, and affective components of the examination was challenging. CONCLUSIONS Technical skills can be included in a case-based assessment using scenarios that address a range of cognitive and affective skills required of physicians. Results may help training programs assess individuals' abilities as well as identify program needs for curricular improvement. This framework might be useful in setting standards for competency and identifying poor performers.
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Affiliation(s)
- Abigail Ford Winkel
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York 10016, USA.
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Freeman RM. Can we prevent childbirth-related pelvic floor dysfunction? BJOG 2012; 120:137-140. [DOI: 10.1111/1471-0528.12092] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2012] [Indexed: 11/26/2022]
Affiliation(s)
- RM Freeman
- Directorate of Obstetrics and Gynaecology; Plymouth Hospitals NHS Trust; Plymouth UK
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Hofmeyr GJ, Novikova N. Perineal dilators for facilitating the second stage of labour. Hippokratia 2012. [DOI: 10.1002/14651858.cd010197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- G Justus Hofmeyr
- University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health; Department of Obstetrics and Gynaecology, East London Hospital Complex; Frere and Cecilia Makiwane Hospitals Private Bag X 9047 East London Eastern Cape South Africa 5200
| | - Natalia Novikova
- Walter Sisulu University; Department of Obstetrics and Gynaecology, East London Hospital Complex; Private Bag X9047 East London South Africa 5200
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Knobel R, Takemoto MLS, Jones RH, Amorim MMR. Avoiding episiotomy is the best strategy to prevent OASIS: response to the article 'episiotomy characteristics and risks for obstetric anal sphincter injuries: a case-control study'. BJOG 2012; 119:1148; author reply 1148-9. [PMID: 22780821 DOI: 10.1111/j.1471-0528.2012.03391.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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