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Lee N, Allen J, Jenkinson B, Hurst C, Gao Y, Kildea S. A pre-post implementation study of a care bundle to reduce perineal trauma in unassisted births conducted by midwives. Women Birth 2024; 37:159-165. [PMID: 37598048 DOI: 10.1016/j.wombi.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/09/2023] [Accepted: 08/14/2023] [Indexed: 08/21/2023]
Abstract
PROBLEM The perineal-bundle is a complex intervention widely implemented in Australian maternity care facilities. BACKGROUND Most bundle components have limited or conflicting evidence and the implementation required many midwives to change their usual practice for preventing perineal trauma. AIM To measure the effect of perineal bundle implementation on perineal injury for women having unassisted births with midwives. METHODS A retrospective pre-post implementation study design to determine rates of second degree, severe perineal trauma, and episiotomy. Women who had an unassisted, singleton, cephalic vaginal birth at term between two time periods: January 2011 - November 2017 and August 2018 - August 2020 with a midwife or midwifery student accoucheur. We conducted logistic regression on the primary outcomes to control for confounding variables. FINDINGS data from 20,155 births (pre-implementation) and 6273 (post-implementation) were analysed. After implementation, no significant difference in likelihood of severe perineal trauma was demonstrated (aOR 0.86, 95% CI 0.71-1.04, p = 0.124). Nulliparous women were more likely to receive an episiotomy (aOR 1.49 95% CI 1.31-1.70 p < 0.001) and multiparous women to suffer a second degree tear (aOR 1.18 95% CI 1.09-1.27 p < 0.001). DISCUSSION This study adds to the growing body of literature which suggests a number of bundle components are ineffective, and some potentially harmful. Why, and how, the bundle was introduced at scale without a research framework to test efficacy and safety is a key concern. CONCLUSION Suitably designed trials should be undertaken on all proposed individual or grouped perineal protection strategies prior to broad adoption.
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Affiliation(s)
- Nigel Lee
- Level 3 Chamberlain Building, School of Nursing Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia.
| | - Jyai Allen
- Molly Wardaguga Research Centre, College of Nursing & Midwifery, Charles Darwin University, Level 11, East building, 410 Ann St, Brisbane, Queensland 4000, Australia.
| | - Bec Jenkinson
- Australian Women and Girl's Health Research Centre, School of Public Health, University of Queensland, Herston, Queensland, Australia.
| | - Cameron Hurst
- Australian Nurse-Family Partnership Program and Molly Wardaguga Research Centre, Level 11, East building, 410 Ann St, Brisbane, Queensland 4000, Australia.
| | - Yu Gao
- Level 3 Chamberlain Building, School of Nursing Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia.
| | - Sue Kildea
- Molly Wardaguga Research Centre, College of Nursing & Midwifery, Charles Darwin University, 17 Grevillea Drive, Sadadeen, Alice Springs 0870, Australia.
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Khalaf A, Al Amri N, Al Qadire M. Childbirth-related episiotomy and tear in relation to risk of postpartum depression: a retrospective cohort study on Omani mothers. J Reprod Infant Psychol 2023:1-14. [PMID: 38153261 DOI: 10.1080/02646838.2023.2300082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/23/2023] [Indexed: 12/29/2023]
Abstract
AIMS/BACKGROUND Studies on the association between perineal trauma (episiotomy and tear) and the risk of postpartum depression in Omani mothers are scarce. This study aimed to screen women for the risk of postpartum depression and associated maternal adverse outcomes (episiotomy and tear) in newly delivered Omani mothers. DESIGN/METHODS Mothers were screened for postpartum depression using only the Edinburgh Postnatal Depression Scale (EPDS), with cut-offs of 1-12 indicating low risk and 13-30 indicating high risk. Data on birth outcomes were collected retrospectively from the medical records. Descriptive analyses, group comparisons, and linear regression analyses were conducted. RESULTS Of the 262 participating mothers (total sample, i.e. mothers with and without depression), 19.0% had an episiotomy, 29.0% had tears, and 52.0% had an intact perineum after their childbirth. The total EPDS score was significantly higher among mothers with episiotomy (10.4, SD = 5.4) compared to those with tears (8.1, SD = 4.8) and those with intact perineum (9.4, SD = 4.9) (p-value <0.05). Lower levels of depression (-2.23 points on average) were significantly (p-value <0.05) associated with higher levels of perineum status (coded as 1 = episiotomy, 2 = other). Mothers who had a tear or episiotomy had on average 1.24 points higher EPDS scores compared to mothers with an intact perineum, although not significant (p-value >0.05). CONCLUSIONS Policymakers and clinicians are recommended to consider following up mothers with adverse birth outcomes to outline the risk of developing postpartum depression, at the same time as they routinely screen all mothers for risk of postpartum depression during their postpartum visits.
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Affiliation(s)
- Atika Khalaf
- The PRO-CARE Group, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
- Fatima College of Health Sciences, Department of Nursing, Ajman, United Arab Emirates
| | - Nawal Al Amri
- College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Mohammad Al Qadire
- College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
- Faculty of Nursing, Al Al-Bayt University, Mafraq, Jordan
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Morganelli G, Fieni S, Dall'Asta A, di Pasquo E, Capozzi VA, Valenti A, Pezzani A, Kiener AJO, Ghi T. Effect of the "shoulder-up" bundle on the incidence of spontaneous perineal injury after vaginal delivery: comparison of 2 historic cohorts after propensity score matching. Am J Obstet Gynecol MFM 2023; 5:101038. [PMID: 37245605 DOI: 10.1016/j.ajogmf.2023.101038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/29/2023] [Accepted: 05/22/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Perineal injury following vaginal delivery represents a major cause of long-term maternal morbidity, and its prevention is among the priorities of modern obstetrical practice. OBJECTIVE This study aimed to investigate whether the systematic implementation of a bundle of maneuvers to prevent perineal injury (ie, the "shoulder-up" bundle) may reduce the rate of spontaneous perineal tears in women delivering at a single tertiary maternity unit. STUDY DESIGN This was a single-center retrospective intervention study including all vaginal deliveries between April 1, 2020 and March 31, 2022. On March 1, 2021, a bundle focused on perineal injury prevention in vaginal deliveries was implemented and introduced as a standard of care. The "shoulder-up" bundle includes the addition of a hands-on technique for the delivery of the posterior shoulder, which is slowly lifted up under the direct visualization of the perineal body, immediately after the disengagement of the anterior shoulder. The labor ward staff underwent dedicated training to acquire expertise on the "shoulder-up" bundle. Little changes in terms of medical and midwifery staffing were recorded during the study period. The incidence of spontaneous second-degree or higher perineal tears was compared between the patients who gave birth before the clinical implementation of the bundle (standard-care group) and those who were delivered following the implementation of the bundle (shoulder-up group). A 1:1 propensity score matching of the 2 groups was done for the variables that proved to be independently associated with the perineal outcome. RESULTS From April 1, 2020 to March 31, 2022, 3671 patients had a vaginal birth at our tertiary care unit (1786 in the standard-care group and 1885 in the "shoulder-up" group) and were enrolled in the study population. Of these, 1191 (32.4%) had a spontaneous second-degree or higher perineal tear. At univariate analysis, nulliparity (59.6% vs 39.1%; P<.001), higher gestational age at delivery (39.8±1.28 vs 39.4±1.97 weeks; P<.001), epidural analgesia (40.6% vs 31.2%; P<.001), vacuum-assisted delivery (9.6% vs 4.0%; P<.001), and birthweight >4 kg (11.0% vs 6.3%; P<.001) were independently associated with the perineal outcome. Following propensity score matching for the above cited factors, the 1703 patients of each group were compared. A significant increase in the rate of intact perineum (71.0% vs 64.1%; P=.014) and a reduction in the incidence of second- (27.2% vs 32.9%; P=.006) and third to fourth-degree perineal tears (1.3% vs 3.0%; P<.001) was demonstrated in the "shoulder-up" group. Among the subgroup of patients undergoing vacuum-assisted delivery, a borderline significant reduction in the rate of obstetrical anal sphincter injury (10.4% vs 2.9%; P=.052) was also observed. CONCLUSION Our study showed that the clinical implementation of the "shoulder-up" bundle at vaginal delivery is associated with a significant reduction in the incidence of spontaneous second-degree or higher perineal tears.
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Affiliation(s)
- Giovanni Morganelli
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy.
| | - Stefania Fieni
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
| | - Andrea Dall'Asta
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
| | - Elvira di Pasquo
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
| | - Vito Andrea Capozzi
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
| | - Alissa Valenti
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
| | - Alessandra Pezzani
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
| | | | - Tullio Ghi
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
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Schwertner-Tiepelmann N, Lorenz K, Schwab F, Beilecke K, Marschke J, Tunn R. Berlin survey on obstetric anal sphincter injury (OASI). Arch Gynecol Obstet 2022; 306:1117-1125. [DOI: 10.1007/s00404-022-06627-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/11/2022] [Indexed: 12/01/2022]
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Hübner M, Rothe C, Plappert C, Baeßler K. Aspects of Pelvic Floor Protection in Spontaneous Delivery - a Review. Geburtshilfe Frauenheilkd 2022; 82:400-409. [PMID: 35392067 PMCID: PMC8983111 DOI: 10.1055/a-1515-2622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022] Open
Abstract
The necessity of increasingly addressing aspects of pelvic floor protection, i.e., prevention of the most frequent female pelvic floor disorders, such as urinary incontinence, faecal incontinence and pelvic organ prolapse, is the result of the steadily improving understanding of the association of pregnancy and delivery with the prevalence of these disorders. About a quarter of all women experience one or more such symptoms during their life. Apart from age and weight, pregnancies and births play an important part. While initial discussion of pelvic floor protection often focused very rapidly on the mode of delivery and elective caesarean section as a possible protective intervention, it has become apparent in the last few decades how varied and wide-ranging the options are that can be used to protect against pelvic floor disorders. The mode of delivery as such is "only" one element among numerous other considerations and has diminished markedly in importance. Interprofessionality and interdisciplinarity undoubtedly represent an important development as resulting recommendations must always be incorporated in an overall context that considers mother and child at the same time. Considering the pelvic floor only certainly does not make sense. This review article will analyze in greater detail important pre-, intra- and postpartum aspects that in their entirety can provide insight into the various aspects of pelvic floor protection. The authors regard the following article as an additional basis for discussion on achieving a sustained reduction in the incidence and prevalence of female pelvic floor disorders.
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Affiliation(s)
- Markus Hübner
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
- Medizinische Fakultät der Universität Tübingen, Tübingen, Germany
| | | | - Claudia Plappert
- Institut für Gesundheitswissenschaften, Abt. Hebammenwissenschaft, Universität Tübingen, Tübingen, Germany
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Klokk R, Bakken KS, Markestad T, Holten-Andersen MN. Modifiable and non-modifiable risk factors for obstetric anal sphincter injury in a Norwegian Region: a case-control study. BMC Pregnancy Childbirth 2022; 22:277. [PMID: 35365116 PMCID: PMC8976330 DOI: 10.1186/s12884-022-04621-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/25/2022] [Indexed: 11/22/2022] Open
Abstract
Background Obstetric anal sphincter injury (OASI) is a common and severe complication of vaginal delivery and may have short- and long-term consequences, including anal incontinence, sexual dysfunction and reduced quality of life. The rate of OASI varies substantially between studies and national birth statistics, and a recent meta-analysis concluded that there is a need to identify unrecognized risk factors. Our aim was therefore to explore both potential modifiable and non-modifiable risk factors for OASI. Methods We performed a case–control study in a single center maternity clinic in South-Eastern Norway. Data were extracted retrospectively from an institutional birth registry. The main outcome measure was the occurrence of the woman’s first-time 3rd or 4th degree perineal lesion (OASI) following singleton vaginal birth after 30 weeks’ gestation. For each woman with OASI the first subsequent vaginal singleton delivery matched for parity was elected as control. The study population included 421 women with OASI and 421 matched controls who gave birth during 1990–2002. Potential risk factors for OASI were assessed by conditional logistic regression analyses. Results The mean incidence of OASI was 3.4% of vaginal deliveries, but it increased from 1.9% to 5.8% during the study period. In the final multivariate regression model, higher maternal age and birthweight for primiparous women, and higher birthweight for the multiparous women, were the only non-modifiable variables associated with OASI. Amniotomy was the strongest modifiable risk factor for OASI in both primi- (odds ratio [OR] 4.84; 95% confidence interval [CI] 2.60–9.02) and multiparous (OR 3.76; 95% CI 1.45–9.76) women, followed by augmentation with oxytocin (primiparous: OR 1.63; 95% CI 1.08–2.46, multiparous: OR 3.70; 95% CI 1.79–7.67). Vacuum extraction and forceps delivery were only significant risk factors in primiparous women (vacuum: OR 1.91; 95% CI 1.03–3.57, forceps: OR 2.37; 95% CI 1.14–4.92), and episiotomy in multiparous women (OR 2.64; 95% CI 1.36–5.14). Conclusions Amniotomy may be an unrecognized independent modifiable risk factor for OASI and should be further investigated for its potential role in preventive strategies.
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Affiliation(s)
- Ragnhild Klokk
- Department of Pediatrics, Innlandet Hospital Trust, Anders Sandvigsgate, 2619, Lillehammer, Norway
| | - Kjersti S Bakken
- Women's Clinic, Innlandet Hospital Trust, Lillehammer, Norway.,Centre for International Health, University of Bergen, Bergen, Norway
| | - Trond Markestad
- Department of Research, Innlandet Hospital Trust, Brumunddal, Norway
| | - Mads N Holten-Andersen
- Department of Pediatrics, Innlandet Hospital Trust, Anders Sandvigsgate, 2619, Lillehammer, Norway. .,Department of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
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Uso de cola cirúrgica no reparo de lacerações perineais intraparto: estudo série de casos. ACTA PAUL ENFERM 2021. [DOI: 10.37689/acta-ape/2021ao02724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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8
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Hammond RK, Naidoo TD. The knowledge and perceptions of healthcare workers regarding obstetrical anal sphincter injuries. A practice audit from a resource-constrained setting. AJOG GLOBAL REPORTS 2021; 1:100021. [PMID: 36277460 PMCID: PMC9563464 DOI: 10.1016/j.xagr.2021.100021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND OBJECTIVE STUDY DESIGN RESULTS CONCLUSION
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Affiliation(s)
- Randall Kegan Hammond
- Department of Obstetrics and Gynaecology, Greys Hospital, Pietermaritzburg, South Africa
- Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Corresponding author: Randall Kegan Hammond, MbChB, FCOG, MMed.
| | - Thinagrin Dhasarathun Naidoo
- Department of Obstetrics and Gynaecology, Greys Hospital, Pietermaritzburg, South Africa
- Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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Gyhagen M, Ellström Engh M, Husslein H, Koelbl H, Nilsson IEK, Schulz J, Wagg A, Milsom I. Temporal trends in obstetric anal sphincter injury from the first vaginal delivery in Austria, Canada, Norway, and Sweden. Acta Obstet Gynecol Scand 2021; 100:1969-1976. [PMID: 34435349 DOI: 10.1111/aogs.14244] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 08/06/2021] [Accepted: 08/08/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Obstetric anal sphincter injuries (OASI) are severe complications that can cause considerable short- and long-term morbidity. Austria, Canada, Norway, and Sweden have similar socio-economic characteristics, and all four countries have access to national birth registers. In this study, we hypothesized that the incidence of OASI should be very similar for different obstetric scenarios in these four countries. Therefore, the aim was to compare the incidence of OASI in these four countries in primiparous women, with spontaneous or instrumental delivery (vacuum or forceps), and in women with a first vaginal birth after cesarean section (VBAC). MATERIAL AND METHODS Aggregated data on 1 933 930 vaginally delivered primiparous women and women with VBAC were retrieved from the birth registers gathered in Austria, Canada, Norway, and Sweden. The annual rate of OASI (ICD-10 codes O70.2-O70.3) was presented as the percentage of women with a spontaneous delivery, vacuum or forceps delivery, and a VBAC during the period 2004-2016. RESULTS The incidence of OASI varied considerably between countries and over time. Canada and Sweden had the highest rates, and Austria and Norway the lowest. In Norway, the rate of OASI decreased consistently for all types of deliveries after introducing a perineal protection program in 2004 (p < 0.001). During vacuum delivery, the incidence of OASI varied between countries from 4.1% to 15.5% across the study period. In Canada and Norway, the rate of OASI after a forceps delivery was similar in 2004 at ~20% and with differing trajectories to 24.3% (β 0.49) and 6.2% (β -1.15) (trend, all p < 0.001) in 2016. CONCLUSIONS This comparative register study suggests that there may be considerable potential for lowering the incidence of OASI. The perineal protection program implemented by Norway has been successful. Each country should critically, without prejudice, analyze their current clinical practices and rate of OASI and consider the best preventive strategy.
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Affiliation(s)
- Maria Gyhagen
- Gothenburg Continence Research Center, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Södra Älvsborgs Hospital, Borås, Sweden
| | - Marie Ellström Engh
- Department of Obstetrics and Gynecology, Akershus University Hospital, and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Heinrich Husslein
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Heinz Koelbl
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Ida E K Nilsson
- Gothenburg Continence Research Center, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Södra Älvsborgs Hospital, Borås, Sweden
| | - Jane Schulz
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Adrian Wagg
- Gothenburg Continence Research Center, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ian Milsom
- Gothenburg Continence Research Center, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Seidenari A, Cuicchi D, Youssef A, Oliver EA, Montaguti E, Bellussi F. Obstetric anal sphincter injuries: strategies for prevention, diagnosis, and management. Minerva Obstet Gynecol 2020; 73:74-81. [PMID: 33249818 DOI: 10.23736/s2724-606x.20.04668-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Obstetric anal sphincter injuries (OASIS) are one of the most common causes of anal incontinence (AI) in women of reproductive age and can have a significant impact on quality of life. However, many women do not report symptoms to their physicians because of embarrassment and shame. Therefore, prevention and diagnosis of the tear is essential. Diagnostic strategies have evolved considerably in recent years, with an increase in prevalence of OASIS as a consequence. The use of 3D endoanal (3D-EAUS) and 4D transperineal ultrasound (4D-TPUS), in addition to standard clinical examination have enhanced the detection of OASIS. Once identified, adequate repair by a skilled practitioner and optimal postpartum management should be ensured in order to reduce the risk of anal incontinence. This review presents the available evidence on strategies for prevention, diagnosis, and management of OASIS.
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Affiliation(s)
- Anna Seidenari
- Department of Medical and Surgical Sciences, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Dajana Cuicchi
- Unit of General Surgery, Medical and Surgical Department, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna Italy
| | - Aly Youssef
- Department of Medical and Surgical Sciences, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Emily A Oliver
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Elisa Montaguti
- Department of Medical and Surgical Sciences, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Federica Bellussi
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA -
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Lin WL, Szu LT, Chou PY, Hsu CS, Chen C, Liang SJ, Chen KH. Does hyoscine N-butylbromide shorten the active phase in labor? A meta-analysis of randomized controlled trials. J Obstet Gynaecol Res 2020; 46:2629-2644. [PMID: 33029904 DOI: 10.1111/jog.14507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 08/02/2020] [Accepted: 09/17/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of the study is to evaluate the therapeutic effect of hyoscine N-butylbromide (HBB) in active phase of labor and its safety to mother and fetus. METHODS A systematic literature search was conducted on Cochrane Library, Pubmed, EMBASE, CINAHL, ClinicalTrials.gov and three databases in Chinese up to March 31, 2020. Randomized controlled trials (RCTs) of HBB administration during the active phase for shortening of spontaneous labor at term compared with placebo were included. Two reviewers assessed the methodological quality and data extraction independently. We calculated pooled risk ratios (RRs), mean differences (MDs) and 95% confidence intervals (CIs) using Review Manager 5.3 software. Intention-to-treat principles and random-effects model were adopted for analysis and pool results. RESULTS In total, 1448 women from 9 RCTs were included in the meta-analysis. The HBB group exhibited significantly decreased durations of active phase (MD -61.1 min; 95% CI: -87.7 to -34.4, I2: 96%), the second stage (MD -2.0 min; 95% CI: -3.4 to -0.5, I2: 62%), and third stage (MD -0.7 min; 95% CI: -1.1 to -0.3, I2: 51%). Intravenous (IV) HBB group and intramuscularly (IM) HBB group were compared to the control group (MD -60.9 min; 95% CI -87.7 to -34.1, I2: 96%). No significant differences were observed in Cesarean section, post-partum hemorrhage, instrumental labor, Apgar scores or any adverse effects. CONCLUSION Hyoscine N-butylbromide had a significant effect of shortening the duration of the active phase of labor without adverse effects. We recommend a single dose of intravenous administrated HBB when a woman undergoes labor augmentation.
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Affiliation(s)
- Wei-Lin Lin
- Department of Obstetrics and Gynecology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Li-Ting Szu
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Pao-Yu Chou
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chun-Sen Hsu
- Department of Obstetrics and Gynecology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chiehfeng Chen
- Division of Plastic Surgery, Department of Surgery & Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, School of Medicine, College of Medicine & Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - So-Jung Liang
- Department of Obstetrics and Gynecology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kee-Hsin Chen
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Evidence-based Knowledge Translation Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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12
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Ginath S, Alcalay M, Ben Ami M, Bssam Abbas Y, Cohen G, Condrea A, Feit H, Gershi H, Gold R, Goldschmidt E, Gordon D, Groutz A, Lavy Y, Levy G, Lowenstein L, Marcus N, Padoa A, Samuelof A, Tevet A, Weintraub AY. The impact of a nationwide hands-on workshop on the diagnostic rates and management of obstetrical anal sphincter Injuries in Israel. Colorectal Dis 2020; 22:1677-1685. [PMID: 32583513 DOI: 10.1111/codi.15220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/14/2020] [Indexed: 02/08/2023]
Abstract
AIM The aim was to evaluate the influence of a half day, hands-on, workshop on the detection and repair of obstetric anal sphincter injuries (OASIs). METHOD Starting in February 2011, hands-on workshops for the diagnosis and repair of OASIs were delivered by trained urogynaecologists in departments of tertiary medical centres in Israel. The structure of the hands-on workshop resembles the workshop organized at the International Urogynecological Association annual conferences. Participants included medical staff, midwives and surgical residents from each medical centre. We collected data regarding the rate of OASIs, 1 year before and 1 year following the workshop, in 11 medical centres. The study population was composed of parturients with the following inclusion criteria: singleton pregnancy, vertex presentation and vaginal delivery. Pre-viable preterm gestations (< 24 weeks), birth weight < 500 g, stillborn, and those with major congenital anomalies, multifoetal pregnancies, breech presentations and caesarean deliveries were excluded from the analysis. RESULTS In the reviewed centres, 70 663 (49.3%) women delivered prior to the workshop (pre-workshop group) and 72 616 (50.7%) women delivered following the workshop (post-workshop group). Third- or fourth-degree perineal tears occurred in 248 women (0.35%) before the workshop, and in 328 (0.45%) following the workshop, a significant increase of 28.7% (P = 0.002). The increase in diagnosis was significant also in women with third-degree tears alone, 226 women (0.32%) before the workshop and 298 (0.41%) following the workshop, an increase of 28.3% (P = 0.005). CONCLUSION The detection rate of OASIs has significantly increased following the hands-on workshop. The implementation of such programmes is crucial for increasing awareness and detection rates of OASI following vaginal deliveries.
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Affiliation(s)
- S Ginath
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Alcalay
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - M Ben Ami
- Department of Obstetrics and Gynecology, Baruch Padeh Medical Center, Poriya, Israel.,Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel
| | - Y Bssam Abbas
- Department of Obstetrics and Gynecology, Baruch Padeh Medical Center, Poriya, Israel.,Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel
| | - G Cohen
- Department of Obstetrics and Gynecology, Bnei Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - A Condrea
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Feit
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Gershi
- Department of Obstetrics and Gynecology, Mayanei HaYeshua Medical Center, Bnei Brak, Israel
| | - R Gold
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Lis Maternity Hospital, Tel Aviv, Israel
| | - E Goldschmidt
- Department of Obstetrics and Gynecology, Bnei Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - D Gordon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Lis Maternity Hospital, Tel Aviv, Israel
| | - A Groutz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Lis Maternity Hospital, Tel Aviv, Israel
| | - Y Lavy
- Department of Obstetrics and Gynecology, Hadassah Mount Scopus, Jerusalem, Israel.,Hebrew University, Jerusalem, Israel
| | - G Levy
- Department of Obstetrics and Gynecology, Mayanei HaYeshua Medical Center, Bnei Brak, Israel
| | - L Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - N Marcus
- Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel.,Department of Obstetrics and Gynecology, Rivka Ziv Medical Center, Safed, Israel
| | - A Padoa
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Yitzhak Shamir Medical Center, Tsrifin, Israel
| | - A Samuelof
- Hebrew University, Jerusalem, Israel.,Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - A Tevet
- Hebrew University, Jerusalem, Israel.,Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - A Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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13
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Marks PMT, Caroci-Becker A, Brunelli WS, Oliveira SGD, Lima MDOP, Riesco MLG. Pain, healing and satisfaction of women after perineal repair with surgical glue and suture. Rev Esc Enferm USP 2020; 54:e03588. [PMID: 32965440 DOI: 10.1590/s1980-220x2018044203588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 09/26/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To compare the intensity of pain, the healing process and women's satisfaction with the repair of perineal trauma during vaginal delivery using surgical glue or suture. METHOD Cross-sectional study aligned with a clinical trial conducted at a maternity in Itapecerica da Serra, São Paulo. The sample consisted of women who were evaluated between 10 and 20 days after delivery. The outcomes were analyzed according to the distribution of women in the experimental group (EG: perineal repair with Glubran-2® surgical glue; n=55) and in the control group (CG: perineal repair with Vicryl® suture thread; n=55). RESULTS 110 puerperal women were evaluated. There was no difference between EG and CG regarding sociodemographic and clinical-obstetric characteristics. The intensity of perineal pain, assessed by the visual numeric scale was lower among women in the EG compared to the CG (p<0.001). According to the REEDA scale, there was no significant difference in perineal healing (p=0.267) between EG and CG. The satisfaction of women with perineal repair, assessed using a five-point scale, was higher with the use of surgical glue (p=0.035). CONCLUSION Surgical glue showed advantages in relation to perineal pain and greater satisfaction for women compared to the use of suture. The healing process was similar for both types of repair.
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Affiliation(s)
- Percela Moscoso Tence Marks
- Universidade de São Paulo, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem, São Paulo, SP, Brazil
| | - Adriana Caroci-Becker
- Universidade de São Paulo, Escola de Artes, Ciências e Humanidades, Curso de Obstetrícia, São Paulo, SP, Brazil
| | - Wesllanny Sousa Brunelli
- Universidade de São Paulo, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem, São Paulo, SP, Brazil
| | | | | | - Maria Luiza Gonzalez Riesco
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Psiquiátrica, São Paulo, SP, Brazil
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14
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Nolan CE, O'Leary BD, Ciprike V. Is the older perineum a safer perineum? Risk factors for obstetric anal sphincter injury. Ir J Med Sci 2020; 190:693-699. [PMID: 32918679 DOI: 10.1007/s11845-020-02358-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 08/31/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Obstetric anal sphincter injury (OASI) is the most common cause of anal incontinence. Identifying risk factors may facilitate change in labour and delivery practice, potentially reducing the risk. The objective of this study is to identify maternal, foetal and intrapartum risk factors for OASI in a regional hospital. METHOD We conducted a retrospective analysis of vaginal deliveries over a 10-year period (2008-2017). Anal sphincter injury was diagnosed by an experienced clinician and classified according to RCOG recommendations. A multiple logistic regression model was created using the presence of OASI as the dependent variable. Coefficients were adjusted for relevant maternal, foetal and intrapartum risk factors. RESULTS During the study period, there were 23,887 vaginal deliveries. Of these births, 18,550 were spontaneous (77.66%), 3746 vacuum-assisted (15.68%), 1196 forceps (5.01%) and 395 sequential instrumental deliveries (1.65%). The overall rate of OASI was 1.76%, with an upward trend seen in nulliparous mothers. Significant factors that increased the risk of OASI were nulliparity, Asian ethnicity, delivery by forceps or sequential instruments, and shoulder dystocia. Vacuum delivery did not significantly increase risk. CONCLUSION Maternal age ≥ 35 years confers a protective effect after adjusting for parity, birth weight and mode of delivery. Given the context of an ageing reproductive population, additional research is required to investigate the impact of maternal age on anal sphincter injury.
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Affiliation(s)
- Ciara E Nolan
- Department of Obstetrics and Gynaecology, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland.
| | - Bobby D O'Leary
- Department of Obstetrics and Gynaecology, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland
| | - Vineta Ciprike
- Department of Obstetrics and Gynaecology, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland
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15
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Bidwell P, Thakar R, Gurol-Urganci I, Harris JM, Silverton L, Hellyer A, Freeman R, Morris E, Novis V, Sevdalis N. Exploring clinicians' perspectives on the 'Obstetric Anal Sphincter Injury Care Bundle' national quality improvement programme: a qualitative study. BMJ Open 2020; 10:e035674. [PMID: 32907894 PMCID: PMC7482496 DOI: 10.1136/bmjopen-2019-035674] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/07/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Obstetric anal sphincter injuries (OASI) can have severe debilitating consequences to women and health systems. The OASI Care Bundle quality improvement programme was introduced in 16 maternity units across England, Scotland and Wales (January 2017 to March 2018) to address increasing OASI rates. OBJECTIVES To explore clinicians' (midwives' and obstetricians') perspectives of the OASI Care Bundle with respect to (1) acceptability, (2) feasibility, and (3) sustainability. DESIGN A qualitative exploratory study using focus groups methodology. SETTING A total of 16 focus groups were conducted in 16 maternity units in England, Scotland and Wales where the OASI Care Bundle was implemented. Focus groups took place approximately 3 months following initial implementation of the care bundle in each unit. PARTICIPANTS A total of 101 clinicians participated, with an average of six per focus group. Participants volunteered to take part and compromised of 37 obstetricians and 64 midwives (including eight students). The majority were female and the mean age was 36.5 years. RESULTS Four main themes emerged: 'Implementation strategies', 'Opportunities to use the OASI Care Bundle', 'Does current practice need to change?' and 'Perceptions of what women want'. Midwives were more likely than obstetricians to report themes alluding to 'what women want' and variations in intrapartum perineal protection techniques. Both professional groups reported similar views of other themes, in particular regarding the supporting clinical evidence. Gaps were identified in clinicians' knowledge and experience of intrapartum perineal management. CONCLUSIONS Adoption of the OASI Care Bundle was associated with a number of cognitive and interpersonal factors, such as personal values, interprofessional working and how the intervention was launched; which both facilitated and impeded adoption. The 'what women want' theme has implications for maternal autonomy and needs further exploration. Our findings can be used by similar initiatives to reduce perineal trauma both nationally and internationally. TRIAL REGISTRATION NUMBER ISCTRN 12143325; https://doi.org/10.1186/ISRCTN12143325.
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Affiliation(s)
- Posy Bidwell
- Royal College of Obstetricians and Gynaecologists, London, UK
| | | | - Ipek Gurol-Urganci
- Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - James M Harris
- Centre for Nursing, Midwifery and Allied Health Professional Research, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | | | - Edward Morris
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - Vivienne Novis
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, King's College London, London, UK
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16
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Manresa M, Kalis V, de Tayrac R, de Leeuw JW, Laine K, Räisänen S, Ismail KM. Hands up if you do not understand hands on. Midwifery 2020; 90:102836. [PMID: 32907704 DOI: 10.1016/j.midw.2020.102836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/02/2020] [Indexed: 11/18/2022]
Affiliation(s)
- M Manresa
- Department of Maternal Fetal Medicine, Hospital Clinic of Barcelona, Spain.
| | - V Kalis
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic; Department of Obstetrics and Gynecology, University Hospital, Pilsen, Czech Republic
| | - R de Tayrac
- Department of Obstetrics and Gynecology, Nîmes University Hospital, University of Montpellier, France
| | - J W de Leeuw
- Department of Obstetrics and Gynaecology, Ikazia Hospital, Rotterdam, the Netherlands
| | - K Laine
- Oslo University Hospital, University of Oslo, Norway
| | - S Räisänen
- Tampere University of Applied Sciences, Tampere, Finland
| | - K M Ismail
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic; Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Charles University, Czech Republic
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17
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Kalis V, Rusavy Z, Havelkova L, Zitka T, Tolar D, Ismail KM. Metrics of perineal support (MOPS) study. BMC Pregnancy Childbirth 2020; 20:361. [PMID: 32527247 PMCID: PMC7291533 DOI: 10.1186/s12884-020-03042-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Manual perineal protection (MPP) is an intrapartum intervention suggested to protect perineal integrity during childbirth. Proper execution of MPP is complex and evaluation of its true contribution is difficult in the clinical setting because of the large number of obstetric variables, some of which are hardly quantifiable. In this study we aimed to gather initial data on the forces executed by the accoucheur's thumb, index and middle fingers during MPP at the time of fetal head expulsion, quantify the duration of the intervention and investigate the timely interaction of the different components of MPP. METHODS Two bespoke right-handed measurement gloves (MG), with built in sensors, were designed and produced. The MG allowed the electronic real-time measurement of applied forces during MPP and transferred this data wirelessly to an integrated computer system. Sterile gloves were worn over the MG when used at the time of birth. The study was undertaken between January and December 2019. Singleton, term pregnant women having their first vaginal birth who provided a valid written consent were enrolled into this prospective pilot study. All deliveries were undertaken by one of two obstetricians experienced in MPP. RESULTS Twenty women were enrolled. The mean duration of execution of MPP during the last contraction was 13.6 s. In 20% it lasted < 5 s. The overall mean values of the average and maximum forces of the thumb, index and middle fingers were 26.7 N; 25.5 N; 20.2 N and 34.3 N; 32.6 N; and 27.6 N respectively. The onset of fingers and thumb activity was simultaneous in 13 cases (65%), while in seven (35%) deliveries the middle finger's force activity was initiated later. CONCLUSIONS MPP during fetal head expulsion happens over a short period of time. In the majority of cases the thumb and fingers actions started simultaneously. There were differences in the duration of application and the forces executed by the fingers and thumb between the two practitioners, however this was only significant for thumb measurements. The results obtained will aid in improving further MPP modeling studies to optimize the technique.
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Affiliation(s)
- Vladimir Kalis
- Department of Gynecology and Obstetrics, University Hospital, alej Svobody 76, 304 60, Pilsen, Czech Republic.,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Zdenek Rusavy
- Department of Gynecology and Obstetrics, University Hospital, alej Svobody 76, 304 60, Pilsen, Czech Republic.,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Linda Havelkova
- New Technologies - Research Centre, University of West Bohemia, Pilsen, Czech Republic
| | - Tomas Zitka
- New Technologies - Research Centre, University of West Bohemia, Pilsen, Czech Republic
| | - David Tolar
- New Technologies - Research Centre, University of West Bohemia, Pilsen, Czech Republic
| | - Khaled M Ismail
- Department of Gynecology and Obstetrics, University Hospital, alej Svobody 76, 304 60, Pilsen, Czech Republic. .,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.
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18
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Luxford E, Bates L, King J. 'Please Squeeze': A novel approach to perineal guarding at the time of delivery reduced rates of obstetric anal sphincter injury in an Australian tertiary hospital. Aust N Z J Obstet Gynaecol 2020; 60:914-918. [PMID: 32500548 DOI: 10.1111/ajo.13181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 04/22/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Over the last decade the incidence of obstetric anal sphincter injuries (OASIS) has been steadily increasing locally and internationally. Investigations into reducing rates, and the long-term complications, of OASIS are required. AIMS To determine if applying a new method of perineal guarding at the time of delivery reduces the incidence of OASIS at an Australian tertiary hospital. MATERIALS AND METHODS A retrospective audit was performed for the three years prior to and following mandatory introduction of a new method of perineal guarding. The novel 'Please Squeeze' technique involved placement of the accoucheur's thumb and index finger just above the line of the posterior fourchette at crowning and bringing them firmly one centimetre postero-medially to reduce tension. Demographic data were extracted from the unit's obstetric database (ObstetriX). RESULTS There were 9453 deliveries prior to, and 9805 deliveries following commencement of 'Please Squeeze', with no difference in the incidence of caesarean (30.4% vs 30.3% P = 0.87) or forceps (6.3% vs 5.8% P = 0.14) between groups. The incidence of primiparas (P = 0.005), ventouse (P < 0.001) and spontaneous vaginal deliveries (SVD) (P = 0.005) between groups. There was a clinically important 20% reduction in the incidence of OASIS across all vaginal deliveries from 3.5% to 2.8% (P = 0.006). In SVD, there was a 20% decrease in OASIS from 2.4% to 2.2% (P = 0.02), and a 14% decrease in OASIS with assisted vaginal delivery from 8% to 7.3% (P = 0.002). The incidence of episiotomy increased 16% (P < 0.001). CONCLUSIONS The novel 'Please Squeeze' perineal guarding method contributed to a reduced incidence of OASIS in an Australian tertiary hospital.
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Affiliation(s)
- Elizabeth Luxford
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, Australia
| | - Lucy Bates
- Pelvic Floor Unit, Westmead Hospital, Sydney, Australia
| | - Jennifer King
- Pelvic Floor Unit, Westmead Hospital, Sydney, Australia
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Forey PL, Lallemant M, Bourtembourg-Matras A, Eckman-Lacroix A, Ramanah R, Riethmuller D, Mottet N. Impact of a selective use of episiotomy combined with Couder's maneuver for the perineal protection. Arch Gynecol Obstet 2020; 302:77-83. [PMID: 32388778 DOI: 10.1007/s00404-020-05572-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 04/25/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the impact of a selective use of episiotomy combined with Couder's maneuver on the incidence of perineal tears in spontaneous term deliveries. METHODS A comparative, retrospective, mono-centric study in a university maternity unit was designed and included all primiparous women who delivered spontaneously after 37 weeks of gestation in cephalic presentation. Two cohorts were studied, before and after the practice of Couder's maneuver. In the first cohort, the ''OSE cohort'' only selective episiotomies were performed from January 2009 to December 2010. In the second cohort, from January 2016 to December 2017, the ''SEC cohort'' selective episiotomies combined with Couder's maneuver were performed by midwives and obstetricians. The primary outcome was the type of perineal tears, according to the Royal College of Obstetricians and Gynaecologists (RCOG) classification. RESULTS A total of 2081 patients were included: 909 patients in the OSE cohort and 1172 patients in the SEC cohort. Couder's maneuver was performed in 59% of the SEC cohort. In the SEC cohort, there were an increase in the number of intact perinea (55% versus 63%, p < 0.001), a decrease in second-degree perineal tears (18% versus 11%, p < 0.001) and a decrease in labia minora tears (48% versus 37%, p < 0.001). The rate of obstetrical anal sphincter injuries was less than 1% in both cohorts (0.3% versus 0.5%, p = 0.7). CONCLUSION A selective use of episiotomy combined with Couder's maneuver could reduce the incidence of perineal tears, particularly second-degree perineal tears, without increasing the rate of obstetrical anal sphincter injuries.
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Affiliation(s)
- Pierre-Louis Forey
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz, University of Franche-Comté, 25000, Besançon, France
| | - Marine Lallemant
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz, University of Franche-Comté, 25000, Besançon, France
| | - Aude Bourtembourg-Matras
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz, University of Franche-Comté, 25000, Besançon, France
| | - Astrid Eckman-Lacroix
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz, University of Franche-Comté, 25000, Besançon, France
| | - Rajeev Ramanah
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz, University of Franche-Comté, 25000, Besançon, France
- Nanomedecine Laboratory, Imagery and Therapeutics, INSERM EA 4662, University of Franche-Comté, 25000, Besançon, France
| | - Didier Riethmuller
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz, University of Franche-Comté, 25000, Besançon, France
| | - Nicolas Mottet
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz, University of Franche-Comté, 25000, Besançon, France.
- Nanomedecine Laboratory, Imagery and Therapeutics, INSERM EA 4662, University of Franche-Comté, 25000, Besançon, France.
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20
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Kleprlikova H, Kalis V, Lucovnik M, Rusavy Z, Blaganje M, Thakar R, Ismail KM. Manual perineal protection: The know‐how and the know‐why. Acta Obstet Gynecol Scand 2020; 99:445-450. [DOI: 10.1111/aogs.13781] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Hana Kleprlikova
- Department of Obstetrics and Gynecology Croydon University Hospital London UK
- Department of General Anthropology Faculty of Humanities Charles University Prague Czech Republic
| | - Vladimir Kalis
- Biomedical Center Faculty of Medicine in Pilsen Charles University Pilsen Czech Republic
- Department of Obstetrics and Gynecology University Hospital Pilsen Czech Republic
| | - Miha Lucovnik
- National Department of Perinatology Division of Obstetrics and Gynecology University Medical Center Ljubljana Slovenia
- Medical Faculty University of Ljubljana Ljubljana Slovenia
| | - Zdenek Rusavy
- Biomedical Center Faculty of Medicine in Pilsen Charles University Pilsen Czech Republic
- Department of Obstetrics and Gynecology University Hospital Pilsen Czech Republic
| | - Mija Blaganje
- National Department of Perinatology Division of Obstetrics and Gynecology University Medical Center Ljubljana Slovenia
- Medical Faculty University of Ljubljana Ljubljana Slovenia
| | - Ranee Thakar
- Department of Obstetrics and Gynecology Croydon University Hospital London UK
| | - Khaled M. Ismail
- Biomedical Center Faculty of Medicine in Pilsen Charles University Pilsen Czech Republic
- Department of Gynecology and Obstetrics Faculty of Medicine in Pilsen Charles University Pilsen Czech Republic
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21
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Van Den Berg K, Dijksman LM, Keus SHJ, Scheele F, Van Pampus MG. Value-based health care in obstetrics. J Eval Clin Pract 2020; 26:101-108. [PMID: 31197893 DOI: 10.1111/jep.13208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/08/2019] [Accepted: 05/13/2019] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES We strive to maximize outcomes that are relevant to the women who deliver in our hospital. We demonstrate a practical method of using value-based health care (VBHC) concepts to analyse how care can be improved. METHOD Using International Consortium of Health Outcome Measurements (ICHOM) set, a practical outcome set was constructed for women who go into spontaneous labour at term of a singleton in cephalic presentation and used for benchmarking. We included data on interventions that are major drivers of outcomes. Data from two hospitals in Amsterdam and for The Netherlands for 2011 to 2015 were collected. RESULTS Benchmarking of readily available data helped identify a number of statistically significant and clinically relevant differences in obstetric outcomes. Caesarean section rate was significantly different at 13.7% in hospital 2 compared with 11.5% in hospital 1 with similar neonatal outcomes. Third and fourth degree tearing rates were significantly higher for hospital 1 at 5.5% compared with 3.6% for hospital 2 and the national average of 3.5%. On the basis of the guidelines, literature, and discussion, initiatives on how to improve these outcomes were then identified. These include caesarean section audit and guidelines regarding caesarean section decision making. In order to reduce the rate of third and fourth degree tearing, routine episiotomy on vaginal operative deliveries was introduced, and a training programme was set up to make care providers more aware of risk factors and potential preventive measures. CONCLUSION Defining, measuring, and comparing relevant outcomes enable care providers to identify improvements. Collection and comparison of readily available data can provide insights in where care can be improved. Insights from literature and comparison of care practices and processes can lead to how care can be improved. Continuous monitoring of outcomes and expanding the set of outcomes that is readily available are key in the process towards value-based care provision.
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Affiliation(s)
- Kim Van Den Berg
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, The Netherlands
| | - Lea Magdalena Dijksman
- Department of Quality and Improvement, St. Antonius Hospital, Utrecht, /Nieuwegein, The Netherlands
| | | | - Fedde Scheele
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, The Netherlands.,Amsterdam University Medical Center, Amsterdam, The Netherlands
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Are women attending a midwifery-led birthing center at increased risk of anal sphincter injury? Int Urogynecol J 2020; 31:583-589. [PMID: 31901952 DOI: 10.1007/s00192-019-04218-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS In recent years there has been renewed interest in midwifery-led care for women, with studies reporting similar neonatal outcomes despite lower rates of intervention in midwifery-led birthing centers. Research into obstetric anal sphincter injuries (OASI) in these birthing centers is scarce. The objective of this study was to compare the rate of OASI after spontaneous vaginal delivery in nulliparous women in consultant or midwifery-led units over a ten-year period. METHODS All spontaneous vaginal deliveries in nulliparous women from 2008 to 2017 were analyzed in a single-center retrospective study. Women who had neuraxial analgesia were excluded. The primary endpoint was OASI. Labor characteristics in both groups were compared, and a multiple regression model was created. RESULTS During the study period, there were 3260 spontaneous vaginal deliveries in nulliparous women; 75.7% (2467/3260) delivered in the consultant-led unit and 24.3% (793/3260) in the midwifery-led unit (MLU). Women delivering in the MLU had a greater risk of anal sphincter injury than those delivering in the CLU (4.9% [39/793] vs 2.5% [62/2467], OR 2.01, 95% CI 1.32 - 3.01). Significant risk factors that increased the risk of OASI on regression analysis were birthweight and delivery in the midwifery-led unit. CONCLUSIONS Women delivering in the midwifery-led unit appear to be at double the risk of OASI when compared to those delivering in the consultant-led unit. These results are in contrast to previous studies in midwifery-led centers. This difference may be site-specific and further research is required before these results form part of patient counseling.
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Levin G, Meyer R, Rottenstreich A. Reducing birth trauma programs - Diagnosis of anal sphincter injuries should be improved. Acta Obstet Gynecol Scand 2019; 99:679. [PMID: 31626720 DOI: 10.1111/aogs.13748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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24
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What is the total impact of an obstetric anal sphincter injury? An Australian retrospective study. Int Urogynecol J 2019; 31:557-566. [PMID: 31529328 PMCID: PMC7093361 DOI: 10.1007/s00192-019-04108-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/28/2019] [Indexed: 11/16/2022]
Abstract
Introduction Most data on obstetric anal sphincter injury (OASI) reflect short-term (< 12 months) or much longer term (> 10 years) impact. This study aimed to collate the extent of medium-term symptomology (1–6 years) and observe the effect on future birth choices to evaluate the cumulative impact of OASI in affected women. Methods A retrospective cohort of women affected by OASI completed a questionnaire covering bowel symptomology, sexual function, life impact and future birth choices. A custom-created adverse composite outcome for OASI incorporating effects on daily life, flatal/fecal incontinence and sexual function (OASIACO) was used as a threshold score to identify women with high levels of symptoms. Results Of 265 eligible and contactable women, 210 questionnaires were received (response rate 79%) at a mean of 4 years post-OASI. More than half (54%) experienced an OASIACO. A forceps birth (p = 0.03) or more severe grade of tear (p = 0.03) was predictive of OASIACO. One hundred one women had further children, with 48% reporting their delivery choices were impacted, 32% electing a cesarean delivery and 26% shifting to private care. Eighty women (40%) had not given birth again, and 29 (36%) of these indicated their OASI influenced this decision. Conclusions The total impact of an OASI on women affected is substantial. More than half experience ongoing symptoms and close to half report an impact on their future birth choices. It follows there would be a consequential load on the healthcare sector, and improved management and prevention programs should be implemented. Electronic supplementary material The online version of this article (10.1007/s00192-019-04108-3) contains supplementary material, which is available to authorized users.
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25
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Sveinsdottir E, Gottfredsdottir H, Vernhardsdottir AS, Tryggvadottir GB, Geirsson RT. Effects of an intervention program for reducing severe perineal trauma during the second stage of labor. Birth 2019; 46:371-378. [PMID: 30444289 DOI: 10.1111/birt.12409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/20/2018] [Accepted: 10/20/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Obstetric anal sphincter injuries lead frequently to short- and long-term consequences for the mother, including perineal pain, genital prolapse, and sexual problems. The aim of the study was to evaluate whether the implementation of an intervention program in the second stage of labor involving altered perineal support techniques reduced severe perineal trauma. METHODS All women reaching the second stage of labor and giving birth vaginally to singleton babies at Landspítali University Hospital (comprising 76% of births in Iceland in 2013) were enrolled in a cohort study. Data were recorded retrospectively for 2008-2010 and prospectively in 2012-2014, for a total of 16 336 births. During 2011, an intervention program was implemented, involving all midwives and obstetricians working in the labor wards. Two professionals assessed and agreed on classification of every perineal tear. RESULTS The prevalence of obstetric anal sphincter injuries decreased from 5.9% to 3.7% after the implementation (P < 0.001). Third-degree tears decreased by 40%, and fourth-degree tears decreased by 56% (P < 0.001). The prevalence of first-degree tears increased from 25.8% to 33.1%, whereas second-degree tears decreased from 44.7% to 36.6% between the before and after study periods. Severe perineal trauma was linked to birthweight, and this did not change despite the new intervention. CONCLUSIONS Active intervention to reduce perineal trauma was associated with an overall significant decrease in obstetric anal sphincter injuries. Good perineal visualization, manual perineal support, and controlled delivery of the fetal head were essential components for reducing perineal trauma.
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Affiliation(s)
- Edda Sveinsdottir
- Midwifery Division, Faculty of Nursing, University of Iceland, Reykjavik, Iceland.,Department of Obstetrics and Gynecology, Women's Clinic, Landspítali University Hospital, Reykjavik, Iceland
| | - Helga Gottfredsdottir
- Midwifery Division, Faculty of Nursing, University of Iceland, Reykjavik, Iceland.,Department of Obstetrics and Gynecology, Women's Clinic, Landspítali University Hospital, Reykjavik, Iceland
| | - Anna S Vernhardsdottir
- Midwifery Division, Faculty of Nursing, University of Iceland, Reykjavik, Iceland.,Department of Obstetrics and Gynecology, Women's Clinic, Landspítali University Hospital, Reykjavik, Iceland
| | | | - Reynir T Geirsson
- Department of Obstetrics and Gynecology, Women's Clinic, Landspítali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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26
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Ali-Masri H, Hassan S, Fosse E, Zimmo KM, Zimmo M, Ismail KMK, Vikanes Å, Laine K. Impact of electronic and blended learning programs for manual perineal support on incidence of obstetric anal sphincter injuries: a prospective interventional study. BMC MEDICAL EDUCATION 2018; 18:258. [PMID: 30419884 PMCID: PMC6233260 DOI: 10.1186/s12909-018-1363-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 10/29/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Obstetric anal sphincter injuries (OASIS) are associated with anal incontinence, dyspareunia and perineal pain. Bimanual perineal support technique (bPST) prevents OASIS. The aim of this study was to assess the effect of two different bPST training-methods on OASIS incidence. METHODS This is a prospective-interventional quality improvement study conducted in two Palestinian maternity units between June 1 2015 and December 31 2016. Women having spontaneous or operative vaginal-delivery at ≥24 gestational-weeks or a birthweight of ≥1000 g (n = 1694) were recruited and examined vaginally and rectally immediately after vaginal birth by a trained assessor. Data on baseline OASIS incidence were collected during Phase-1 of the study. Subsequently, birth attendants in both maternity units were trained in bPST using two training modalities. A self-directed electronic-learning (e-learning) using an animated video was launched in phase-2 followed by a blended learning method (the animated e-learning video+ structured face-to-face training) in phase-3. OASIS incidence was monitored during phases-2 and 3. Variations in OASIS incidence between the three phases were assessed using Pearson-χ2-test (or Fisher's-Exact-test). The impact of each training-method on OASIS incidence was assessed using logistic-regression analysis. RESULTS A total of 1694 women were included; 376 in phase-1, 626 in phase-2 and 692 in phase-3. Compared to Phase-1, OASIS incidence was reduced by 45% (12.2 to 6.7%, aOR: 0.56, CI; 0.35-0.91, p = 0.018) and 74% (12.2 to 3.2%, aOR, 0.29, CI; 0.17-0.50, p < 0.001) in phases-2 and 3, respectively. There was also a significant reduction in OASIS incidence by 52% from phase-2 to phase-3 (6.7% (42/626) to 3.2% (22/692), p = 0.003). These reductions reached statistical significance among parous-women only (aOR: 0.18, CI; 0.07-0.49, p = 0.001) after the first training method tested in phase-2. However, the reduction was significant among both primiparous (aOR: 0.39, CI; 0.21-0.74, p = 0.004) and parous-women (aOR: 0.11, CI; 0.04-0.32, p < 0.001) after implementing the blended learning method in phase-3. CONCLUSION The animated e-learning video had a positive impact on reducing OASIS incidence. However, this reduction was enhanced by the use of a blended learning program combining both e- learning and face-to-face training modalities. STUDY REGISTRATION NUMBER ClinicalTrialo.gov identifier: NCT02427854 , date: 28 April 2015.
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Affiliation(s)
- Hadil Ali-Masri
- Department of Obstetrics, Palestine Medical Complex, Ramallah, Palestine
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sahar Hassan
- Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Ramallah, Palestine
| | - Erik Fosse
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kaled M. Zimmo
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Obstetrics, Al Aqsa Martyrs Hospital, Gaza, Palestine
| | - Mohammed Zimmo
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Obstetrics, Al Shifa Hospital, Gaza, Palestine
| | | | - Åse Vikanes
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Katariina Laine
- Department of Obstetrics, Oslo University Hospital, Ullevål, Oslo, Norway
- Department of Health Management and Health Economics, Institute for Health and Society, University of Oslo, Oslo, Norway
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27
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Riethmuller D, Ramanah R, Mottet N. [Fetal expulsion: Which interventions for perineal prevention? CNGOF Perineal Prevention and Protection in Obstetrics Guidelines]. ACTA ACUST UNITED AC 2018; 46:937-947. [PMID: 30377094 DOI: 10.1016/j.gofs.2018.10.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The objective for all obstetricians and midwifes who intervene during the release of the fetal presentation is to prevent at best the perineal lesions. This work consisted in analyzing the literature, researching and evaluating interventions that reduce this perineal risk during the release. METHODS A keyword search for each medical intervention during the expulsion phase was conducted by selecting studies assessing perineal risk. Interventions during pregnancy and during delivery before the expulsion phase were specifically addressed in other sections of the recommendations. RESULTS Firstly, the degree of perineal stretching during the second stage of labour does not appear to be a risk factor for OASIS, postpartum incontinence, or sexual disorders (LE3) and that a substantial stretching of the perineum is not an indication of episiotomy (Professional consensus). Then, manual control of the expulsion of the fetus at the end of the second stage of labour and support of the posterior perineum during this time appear to reduce the rate of OASIS (LE3). The crowning of the baby's head should be manually controlled and the posterior perineum manually supported manually to reduce the risk of OASIS (GradeC). There is no recognised benefit to episiotomy in normal deliveries (LE1); the liberal practice of episiotomy results in fewer intact perineums than its restrictive practice, and the latter does not result in increasing the number of cases of OASIS. No evidence indicates that an episiotomy for women with a breech presentation, twin pregnancy, or posterior position prevents OASIS (LE3). Indication for episiotomy during delivery depends on individual risk factors and obstetric conditions (Professional consensus). It is recommended that the indication for episiotomy be explained and the woman's consent received before its performance. The performance of an episiotomy during normal deliveries is not recommended to reduce the risk of OASIS (Grade A). The liberal practice of episiotomy to prevent OASIS is not recommended for women with a breech presentation, twin pregnancy, or posterior position (GradeC). Episiotomy during an instrumental delivery appears to be associated with a reduction of the risk of OASIS (LE3). The vacuum extractor appears to induce fewer cases of OASIS than other instruments (LE3). Episiotomy may be indicated in instrumental deliveries to avoid OASIS (GradeC). Training in perineal protection in obstetrics is recommended (Grade B). In operative vaginal deliveries when several instruments can be used, a vacuum extractor is preferentially recommended to reduce the risk of OASIS (GradeC). When forceps or spatulas are used, it is preferable that they be withdrawn just before cephalic deflexion so that the fetal head is not "capped" with these instruments at birth (Professional consensus). Couder's maneuver, which consists of lowering the forearm during the release of the fetal shoulders, appears to decrease the rate of second-degree perineal tears and increase the rate of intact perineum (LE3). CONCLUSION Manual control of the expulsion and perineal support reduce the risk of perineal injury. There is no benefit to episiotomy in normal delivery, nor in special cases such the breech presentation for example. On the other hand, in case of instrumental delivery, an episiotomy may be indicated to avoid OASIS (GradeC), and it is recommended if it is possible to use the ventouse preferentially. The Couder's maneuver seems to reduce the rate of 2nd degree perineal lesions (LE3). Finally, training in perineal obstetric protection is recommended (Grade B).
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Affiliation(s)
- D Riethmuller
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France.
| | - R Ramanah
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - N Mottet
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
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Affiliation(s)
- Mary Steen
- Professor of Midwifery, School of Nursing and Midwifery, University of South Australia
| | - Monica Diaz
- Research and clinical midwife, School of Nursing and Midwifery, University of South Australia and Women and Children's Hospital, Adelaide
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29
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Antonakou A. Hands-on or hands-off the perineum at childbirth: A re-appraisal of the available evidence. Eur J Midwifery 2017. [DOI: 10.18332/ejm/78588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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30
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Are obstetric outcomes affected by female genital mutilation? Int Urogynecol J 2017; 29:339-344. [DOI: 10.1007/s00192-017-3466-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/18/2017] [Indexed: 12/24/2022]
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de Tayrac R, Carligny L, Zimmerman R, Huberlant S, Letouzey V. Quelles mesures de protection périnéale à l’accouchement sont consensuelles en France ? Résultats d’une enquête Delphi. Prog Urol 2017; 27:413-423. [DOI: 10.1016/j.purol.2017.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/25/2017] [Accepted: 04/17/2017] [Indexed: 11/26/2022]
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Ginath S, Mizrachi Y, Bar J, Condrea A, Kovo M. Obstetric Anal Sphincter Injuries (OASIs) in Israel: A Review of the Incidence and Risk Factors. Rambam Maimonides Med J 2017; 8:RMMJ.10295. [PMID: 28467760 PMCID: PMC5415364 DOI: 10.5041/rmmj.10295] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Obstetric anal sphincter injuries (OASIs) following vaginal deliveries are the main reason for subsequent development of anal incontinence in women. The diagnosis of such tears is crucial for treating and preventing such a grave sequela. The reported rate of OASIs in Israel was between 0.1% and 0.6%, out of all vaginal births, which is 10-fold lower than that reported in Europe and the United States. Structured hands-on training in repair of OASIs in seven medical centers in Israel significantly increased the detection rate of third-degree perineal tears. The implementation of such programs is crucial for increasing awareness and detection rates of OASIs following vaginal deliveries.
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Affiliation(s)
- Shimon Ginath
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Mizrachi
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Condrea
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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