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Seijmonsbergen-Schermers AE, Peerdeman KMCM, van den Akker T, Titulaer LML, Roovers JP, Peters LL, Verhoeven CJ, de Jonge A. Differences in rates of severe perineal trauma between midwife-led and obstetrician-led care in the Netherlands: A nationwide cohort study. Heliyon 2024; 10:e24609. [PMID: 38312656 PMCID: PMC10835235 DOI: 10.1016/j.heliyon.2024.e24609] [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: 10/12/2023] [Revised: 12/15/2023] [Accepted: 01/11/2024] [Indexed: 02/06/2024] Open
Abstract
Objective To investigate trends and rates of severe perineal trauma (SPT), also known as obstetric anal sphincter injury (OASI), between midwife-led and obstetrician-led care in the Netherlands, and factors associated with SPT. Methods This nationwide cohort study included registry data from 2000 to 2019 (n = 2,169,950) of spontaneous vaginal births of term, live, cephalic, single infants, without a (previous) caesarean section or assisted vaginal birth.First, trends of SPT and episiotomy were shown. Second, differences in SPT rates between midwife- and obstetrician-led care were assessed. Third, associations of care factors with SPT were examined. Multivariable logistic regression analyses were used to determine which factors were important in the associations. All outcomes were stratified for parity. Results Over time, the SPT incidence increased mainly in midwife-led care and episiotomy rates decreased. Compared to midwife-led care, SPT rates were lower in obstetrician-led care among primiparous women (aOR 0.78; 99 % CI 0.74-0.81) and comparable among multiparous women (aOR 1.04; 99 % CI 0.99-1.10). Among women without epidural analgesia, these differences were smaller for primiparous women (aOR 0.88; 99 % CI 0.84-0.92), but the SPT rate was higher in obstetrician-led care among multiparous women (aOR 1.09; 99 % CI 1.03-1.15). Among women without shoulder dystocia, induction, augmentation, and pain medication, SPT rates were comparable among primiparous women, but higher among multiparous women in obstetrician-led care. In midwife-led care, SPT occurred more often among hospital versus home births. In obstetrician-led care, lower SPT incidences were found among births with epidural analgesia and for multiparous women with induction or augmentation. Conclusions Iinduction, augmentation, and epidural analgesia in obstetrician-led care may be an explanatory factor for the higher incidence of SPT among primiparous women in midwife-led care. More research is needed to explain differences in SPT rates and to understand how SPT can be prevented, while maintaining a high intact perineum rate.
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Affiliation(s)
- Anna E. Seijmonsbergen-Schermers
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands
| | - Kelly MCM. Peerdeman
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, Netherlands
- Athena Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081, HV, Amsterdam, Netherlands
| | - Linde ML. Titulaer
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands
| | - Jan-Paul Roovers
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
| | - Lilian L. Peters
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands
| | - Corine J. Verhoeven
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, Netherlands
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Amsterdam Reproduction and Development, Amsterdam, Netherlands
| | - Ank de Jonge
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
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Regional and clinical guidelines for prevention and care of obstetric anal sphincter injuries - A critical frame analysis. Midwifery 2023; 119:103608. [PMID: 36739637 DOI: 10.1016/j.midw.2023.103608] [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: 05/27/2022] [Revised: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Policy documents govern how the prevention and care of obstetric anal sphincter injuries (OASIS) are implemented. Thus, in the absence of Swedish national guidelines on OASIS, differing views may be visible in the regional and local policy documents. Therefore, we aimed to analyse regional and local policies, guidelines, and care programs on the prevention of OASIS and care for OASIS-affected women in a Swedish context by applying a critical frame analysis inspired by Verloo. DESIGN AND SETTING A cross-sectional study of existing policy documents from Swedish healthcare regions was performed. The documents were analysed using Verloo's critical frame analysis. FINDINGS We found that OASIS was framed as a preventable problem addressed by skilled protective manoeuvres of the healthcare staff. Education, communication, and teamwork were three frames of crucial solutions to minimise the prevalence of OASIS. However, complicating power dimensions between professional groups and between professionals and birthing women were identified. Furthermore, several discursive struggles were found, predominantly regarding the scientific evidence for the suggested prevention and care. CONCLUSION The policy documents emphasised that OASIS is preventable, and improved education, communication, and teamwork could diminish the OASIS prevalence. Nevertheless, power dimensions and discursive struggles may challenge the preventive efforts. Furthermore, each Swedish region has the sovereignty to develop its policies, which was reflected in our findings and may imply inequities in care provision. Thus, there is an urgent need to develop comprehensive national high-quality guidelines of high quality for OASIS prevention and care so that all women giving birth have access to equal care and treatment in Sweden.
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Ulfsdottir H, Johnson K, Rubertsson C, Ekelin M, Edqvist M. A complex and demanding situation - Midwifery preceptors and midwifery students' experiences of teaching and learning prevention of severe perineal trauma. Women Birth 2023; 36:e118-e124. [PMID: 35568665 DOI: 10.1016/j.wombi.2022.05.003] [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: 01/20/2022] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Many high-income countries have seen an increase in severe perineal trauma. Teaching strategies and conditions for learning during the active second stage of labour are scarcely described. AIM To describe midwifery preceptors and midwifery students' experiences' of teaching and learning how to manage the second stage of labour, with the specific aim of preventing severe perineal trauma. METHODS A qualitative study with focus group discussions and individual in depth-interviews with preceptor midwives (n = 23) and student midwives (n = 10). Data were analysed by qualitative content analysis. RESULTS "A complex and demanding situation with mutual need for feedback, reflection and safety" was the overall theme describing the conditions. Three sub-themes were identified. "Adapting to a unique situation" refers to the difficulty of teaching and learning the aspects needed to prevent severe perineal trauma, and to provide care during this stage. "Hindering and limiting circumstances" describes teaching strategies that were perceived negatively, and how midwifery students tried to adapt to the preceptors rather than the birthing women. "A trustful and communicative relationship" describes the importance of the relationship between the student and the preceptor, where communication was a central, but not obvious part. CONCLUSION An increased awareness among preceptors is needed to optimize teaching strategies, enabling the students to focus on learning the art of the second stage of labour; supporting the woman, preventing severe perineal trauma and ensuring the safety of the unborn baby. Future research should address how existing prevention models can include training to increase preceptors' confidence in teaching.
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Affiliation(s)
- H Ulfsdottir
- Department of Women's Health and Health professions Karolinska University Hospital, Stockholm, Sweden
| | - K Johnson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - C Rubertsson
- Department of Health Sciences, Faculty of Medicine, Lund University, Sweden
| | - M Ekelin
- Department of Health Sciences, Faculty of Medicine, Lund University, Sweden
| | - M Edqvist
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Spontaneous Perineal Trauma during Non-Operative Childbirth—Retrospective Analysis of Perineal Laceration Risk Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137653. [PMID: 35805312 PMCID: PMC9266119 DOI: 10.3390/ijerph19137653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022]
Abstract
Childbirth-related perineal trauma (CRPT) is defined as damage to the skin, muscles of the perineum, as well as to the anal sphincter complex and anal epithelium. The aim of the study was to analyze the risk factors for spontaneous injuries to the soft tissues of the birth canal during non-operative delivery. This was a single-center retrospective case-control study. The study included the analysis of two groups, the study group featured 7238 patients with spontaneous perineal laceration (any degree of perineal laceration) and the control group featured patients without perineal laceration with 7879 cases. The analysis of single-factor logistic regression showed that the factors related to perineal laceration during childbirth are the age of the patients giving birth (p = 0.000), the BMI before delivery (p = 0.000), the number of pregnancies (p = 0.000) and deliveries (p = 0.000), diagnosed gestational diabetes (p = 0.046), home birth (p = 0.000), vaginal birth after cesarean (VBAC) (p = 0.001), the use of oxytocin in the second stage of childbirth (p = 0.041), the duration of the second stage of childbirth (p = 0.000), body weight (p = 0.000), and the circumference of the newborn head (p = 0.000). Independent factors that increase the risk of perineal laceration during childbirth are an older age of the woman giving birth, a history of cesarean section, a higher birth weight of the newborn, and factors that reduce the risk of spontaneous perineal trauma are a higher number of deliveries and home birth.
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Rottenstreich M, Rotem R, Mor P, Reichman O, Rottenstreich A, Grisaru-Granovsky S, Sela HY. Midwife annual delivery workload and maternal and neonatal adverse outcomes, is there an association? Eur J Obstet Gynecol Reprod Biol 2021; 262:147-154. [PMID: 34022592 DOI: 10.1016/j.ejogrb.2021.05.024] [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: 03/25/2021] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In recent years there has been growing interest in the relationship between the workload of an individual practitioner and its short- and long-term consequences on birth outcomes. In this respect, data is limited with regard to midwives' workload. We aimed to evaluate the association between midwives' annual birth workload and the short-term, adverse maternal and neonatal outcomes occurring at birth. STUDY DESIGN This retrospective cohort study was performed in a single tertiary academic center between 2006 and 2018. All single, live vertex term vaginal births were included and categorized into two groups based on the midwife's median annual volume of births during the study duration. The "high-volume" and "low-volume" groups included births above and below the median annual volume, respectively as a dichotomous variable. Further analyses were performed for the annual volume by deciles. Short term maternal and neonatal outcomes were compared between groups and between deciles. RESULTS During the study period 140,856 births met the study criteria. The median annual volume of births of a single midwife was 152 [114-195]. Maternal and labor characteristics were comparable between the groups. Maternal outcomes were not significantly associated with the midwifes' annual workload. However, neonates delivered by midwives with "low" annual volume had higher rate of neonatal jaundice (aOR 1.07, 95 % CI [1.00-1.14]) and mechanical ventilation (aOR 1.32, 95 % CI [1.05-1.66). CONCLUSION Adverse perinatal outcomes are only mildly affected by midwives' annual volume after controlling for the midwife, parturient and neonate's characteristics.
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Affiliation(s)
- Misgav Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel; Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
| | - Pnina Mor
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Orna Reichman
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Hen Y Sela
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
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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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Akın B, Balçık Çolak M, Öztürk Can H, Küni F. Practices of midwives working in delivery rooms for protection of perineum during intrapartum period and their feedback on these applications. J Matern Fetal Neonatal Med 2020; 35:24-29. [PMID: 32878505 DOI: 10.1080/14767058.2020.1812573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Perineal traumas occurring during labor are undesirable for both the midwives and the woman. Midwives and obstetricians could use different techniques to protect the perineum. PURPOSE The aim of this study was to determine the practices of midwives working in the delivery room to protect the perineum during the second stage of labor. METHODS This is a prospective observational study regarding practices of midwifes for protection of perineum during intrapartum period. The study was conducted with a total of 20 midwives in a maternity unit of an training and research hospital. The data were collected through the forms prepared by the researchers. FINDINGS The average age of the midwives was 34 ± 8.77. The majority of midwives (n: 17, 85%) believed that the need for practices to protect the perineum during labor; 40% of them used perineal protection (hands on) technique to protect perineum and they preferred to perform routine episiotomy in all primiparas. RESULTS AND CONCLUSIONS As a result of the study, it was observed that evidence-based practices was not applied sufficiently enough by the midwives although they were knowledgeable and believed that they are beneficial. Studies are needed for the obstacles to these practices to be identified and removed.
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Affiliation(s)
- Bihter Akın
- Faculty of Health Sciences, Midwifery Department, Selcuk University, Konya, Turkey
| | - Melek Balçık Çolak
- Faculty of Health Science, Midwifery Department, Ege University, Izmir, Turkey
| | - Hafize Öztürk Can
- Faculty of Health Science, Midwifery Department, Ege University, Izmir, Turkey
| | - Filiz Küni
- Maternity Unit, Sakarya Training and Research Hospital, Sakarya, Turkey
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Gómez-Cedillo A, Nieto S, Isla R, Villegas Y, Muñoz E. Obstetric anal sphicnter injury in a Spanish hospital. Eur J Obstet Gynecol Reprod Biol 2020; 255:242-246. [PMID: 33256921 DOI: 10.1016/j.ejogrb.2020.08.032] [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: 06/04/2020] [Revised: 08/06/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Estimation of the prevalence of obstetric anal sphincter injury (OASIS) in our environment and study of the associated risk factors. STUDY DESING A retrospective observational study of cases and controls of assisted deliveries at the Severo Ochoa University Hospital of Leganés during the period from January 1, 2012, to December 31, 2017. A total of 88 OASIS diagnosed in the study period is compared with a randomly selected group of 181 controls of similar characteristics, vaginal births of cephalic of 36 weeks gestation or more, occurring during the same period. RESULTS During the study period, a total of 8160 deliveries were attended in our hospital, of which 6187 were vaginal and we diagnosed a total of 88 OASIS at the time of delivery. The prevalence of OASIS is 1.07 % for total births and 1.42 % for total vaginal deliveries. In the case-control study, the univariate analysis shows statistical significance for nulliparity (OR 3.84; 95 % CI 2.155-6.834; p < 0.001), instrumental delivery (OR 8.73; 95 % CI 4.706-16.2016; p < 0.001), occipital posterior position (OR 7.23; 95 % CI 2.535-20.633; p < 0.001), long duration of the second stage of labor (OR 1.99; IC95 % 1,159-3,438; p 0.01), episiotomy (OR 3.51; 95 % CI 1,956-6,309; p < 0.001) and OBGYN labor assistant (<0.001). When performing the multivariate analysis, forceps delivery (OR19.68), Thierry spatulas delivery (OR 8.15), vacuum delivery (OR 2.74), nulliparity (OR 2.56) and fetal weight in grams (OR 1.12) remain significant in the final model. CONCLUSION The main risk factors for the onset of OASIS are instrumental delivery, nulliparity and fetal birth weight.
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Affiliation(s)
- A Gómez-Cedillo
- Hospital Universitario Severo Ochoa de Leganés, Madrid, Spain.
| | - S Nieto
- Hospital Universitario Severo Ochoa de Leganés, Madrid, Spain
| | - R Isla
- Hospital Universitario Severo Ochoa de Leganés, Madrid, Spain
| | - Y Villegas
- Hospital Universitario Severo Ochoa de Leganés, Madrid, Spain
| | - E Muñoz
- Hospital Universitario Severo Ochoa de Leganés, Madrid, Spain
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Kopeć-Godlewska K, Pac A, Różańska A, Wójkowska-Mach J. Is Vaginal Birth without an Episiotomy a Rarity in the 21st Century? Cross-Sectional Studies in Southern Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2462. [PMID: 30400584 PMCID: PMC6266457 DOI: 10.3390/ijerph15112462] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 11/01/2018] [Indexed: 11/17/2022]
Abstract
Purpose: The objective of this study was to analyze the birth methods (vaginal, with medical intervention, or by Cesarean Section, CS) predominant in the Malopolska province, to describe the risk factors for non-physiologically normal births, and to characterize the demographics of women who give birth and selected parameters of maternity care. Methods: The retrospective analysis was conducted on data collected in 2013⁻2014 in the framework of the current activity of the Polish National Health Fund and encompassed 68,894 childbirths from 29 hospitals in 21 towns in the south of Poland. Results: In the study period, 38,366 (56.5%) of the births in Malopolska were vaginal, and only 22,839 (22.9%) of births were considered 'normal', without an episiotomy. The remaining were births by CS (29,551; 43.5%). Factors increasing the chances of having a normal childbirth in comparison with birth by CS were as follows: days free from work, living in a village, woman's age > 35 years, and the hospital's referral level (primary or secondary). Women aged 18⁻34 years and those living in a village/town were more frequently admitted directly into the birth room without a stay in the maternity units. There was a high level of medicalization of births in Malopolska: natural labour and childbirth were rare. It seems that efforts to increase natural birth rates should be directed toward both reducing the CS rate as well as increasing vaginal birth without an episiotomy.
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Affiliation(s)
- Katarzyna Kopeć-Godlewska
- Faculty of Health Sciences, Jagiellonian University Medical College, ul. Michałowskiego 12, 31-126 Krakow, Poland.
| | - Agnieszka Pac
- Institute of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, ul. Kopernika 7a, 31-034 Krakow, Poland.
| | - Anna Różańska
- Chair of Microbiology, Jagiellonian University Medical College, ul. Czysta 18, 31-121 Kraków, Poland.
| | - Jadwiga Wójkowska-Mach
- Chair of Microbiology, Jagiellonian University Medical College, ul. Czysta 18, 31-121 Kraków, Poland.
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Zhang M, Wang M, Zhao X, Ren J, Xiang J, Luo B, Yao J. Risk factors for episiotomy during vaginal childbirth: A retrospective cohort study in Western China. J Evid Based Med 2018; 11:233-241. [PMID: 30160052 DOI: 10.1111/jebm.12316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 08/02/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To assess the incidence rates and risk factors for episiotomy during vaginal childbirth in a Western China context. METHODS A retrospective hospital-based cohort study was conducted using computerized data of 3721 singleton vaginal deliveries after 28 weeks of gestation. Women who underwent episiotomy were compared with those who did not. RESULTS The overall prevalence of episiotomy was 44.0% (1636/3721); 52.9% (1458/2756) among primiparas and 18.4% (178/965) among multiparas (P < 0.001). Adjusted risk factors significantly associated with episiotomy included primiparity, prolonged second stage of labor, and labor-management personnel. Risk factors specific to primiparas were increasing maternal age (per year) (OR = 1.04, 95% CI 1.01 to 1.07, P = 0.035), increasing biparietal diameter (per centimeter) (OR = 1.40, 95% CI 1.06 to 1.84, P = 0.017), first stage of labor beyond 10-hour (OR = 1.36, 95% CI 1.10 to 1.68, P = 0.005), and birth weight (per 100 g) (OR = 1.06, 95% CI 1.03 to 1.09, P < 0.001). Birth weight resulted in an adjusted risk increase of 6.1% among primiparas for every 100 additional grams of birth weight. For the analysis stratified by labor-management personnel, moderately experienced midwifery was a risk factor of episiotomy (OR = 1.76, 95% CI 1.21 to 2.56, P = 0.003); midwives with bachelor's degree (OR = 1.47, 95% CI 1.15 to 1.88, P = 0.002), and obstetricians with doctor's degree (OR = 2.00, 95% CI 1.18 to 3.39, P = 0.010) were most likely to perform episiotomy. CONCLUSION Episiotomy is still commonly performed in Western China. A survey of maternity care professionals' knowledge of and attitudes towards episiotomy is urgently required to explore the complex reasons for conducting episiotomy.
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Affiliation(s)
- Mengqin Zhang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, P. R. China
| | - Min Wang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, P. R. China
| | - Xiufang Zhao
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, P. R. China
| | - Jianhua Ren
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, P. R. China
| | - Jie Xiang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, P. R. China
| | - Biru Luo
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, P. R. China
| | - Jianrong Yao
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, P. R. China
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Thubert T, Cardaillac C, Fritel X, Winer N, Dochez V. [Definition, epidemiology and risk factors of obstetric anal sphincter injuries: CNGOF Perineal Prevention and Protection in Obstetrics Guidelines]. ACTA ACUST UNITED AC 2018; 46:913-921. [PMID: 30385355 DOI: 10.1016/j.gofs.2018.10.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim of this review was to agree on a definition of the obstetric anal sphincter injuries (OASIS), to determine the prevalence and risk factors. METHODS A comprehensive review of the literature on the obstetric anal sphincter injuries (OASIS), establishment of levels of evidence (NP), and grades of recommendation according to the methodology of the recommendations for clinical practice. RESULTS To classify obstetric anal sphincter injuries (OASIS), we have used the WHO-RCOG classification, which lists 4 degrees of severity. To designate obstetric anal sphincter injuries, we have used the acronym OASIS, rather than the standard French terms of "complete perineum" and "complicated complete perineum". OASIS with only isolated involvement of the EAS (3a and 3b) appears to have a better functional prognosis than OASIS affecting the IAS or the anorectal mucosa (3c and 4) (LE3). The prevalence of women with ano-rectal symptoms increases with the severity of the OASIS (LE3). In the long term, 35-60% of women who had an OASIS have anal or fecal incontinence (LE3). The prevalence of an OASI in the general population is between 0.25 to 6%. The prevalence of OASIS in primiparous women is between 1.4 and 16% and thus, should be considered more important than among the multiparous women (0.4 to 2.7%). In women with a history of previous OASIS, the risk of occurrence is higher and varies between 5.1 and 10.7% following childbirth. The priority in this context remains the training of childbirth professionals (midwives and obstetricians) to detect these injuries in the delivery room, immediately after the birth. The training and awareness of these practitioners of OASIS diagnosis improves its detection in the delivery room (LE2). Professional experience is associated with better detection of OASIS (LE3) (4). Continuing professional education of obstetrics professionals in the diagnosis and repair of OASIS must be encouraged (Grade C). In the case of second-degree perineal tear, the use of ultrasound in the delivery room improves the diagnosis of OASIS (LE2). Ultrasound decreases the prevalence of symptoms of severe anal incontinence at 1 year (LE2). The diagnosis of OASIS is improved by the use of endo-anal ultrasonography in post-partum (72h-6weeks) (LE2). The principal factors associated with OASIS are nulliparity and instrumental (vaginal operative) delivery; the others are advanced maternal age, history of OASIS, macrosomia, midline episiotomy, posterior cephalic positions, and long labour (LE2). The presence of a perianal lesion (perianal fissure, or anorectal or rectovaginal fistula) is associated with an increased risk of 4th degree lacerations (LE3). Crohn's disease without perianal involvement is not associated with an excess risk of OASIS (LE3). For women with type III genital mutilation, deinfibulation before delivery is associated with a reduction in the risk of OASIS (LE3); in this situation, deinfibulation is recommended before delivery (grade C). CONCLUSION It is necessary to use a consensus definition of the OASIS to be able to better detect and treat them.
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Affiliation(s)
- T Thubert
- Service de gynécologie-obstétrique, hôpitaux de Nantes, CHU Hôtel-Dieu, 38, boulevard Jean-Monnet, 44000 Nantes, France; Université de Nantes, 1, rue Gaston-Veil, 44000 Nantes, France; GMC-UPMC 01, GREEN (Groupe de recherche clinique en neurourologie), 4, rue de la Chine, 75020 Paris, France.
| | - C Cardaillac
- Service de gynécologie-obstétrique, hôpitaux de Nantes, CHU Hôtel-Dieu, 38, boulevard Jean-Monnet, 44000 Nantes, France; Université de Nantes, 1, rue Gaston-Veil, 44000 Nantes, France
| | - X Fritel
- Service de gynécologie-obstétrique, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - N Winer
- Service de gynécologie-obstétrique, hôpitaux de Nantes, CHU Hôtel-Dieu, 38, boulevard Jean-Monnet, 44000 Nantes, France; Université de Nantes, 1, rue Gaston-Veil, 44000 Nantes, France
| | - V Dochez
- Service de gynécologie-obstétrique, hôpitaux de Nantes, CHU Hôtel-Dieu, 38, boulevard Jean-Monnet, 44000 Nantes, France; Université de Nantes, 1, rue Gaston-Veil, 44000 Nantes, France
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Sadler LC, McAra-Couper J, Pittam D, Wise MR, Thompson JMD. Risk of perinatal mortality in the first year of midwifery practice in New Zealand: analysis of a retrospective national cohort. BMJ Open 2018; 8:e019026. [PMID: 29627807 PMCID: PMC5892737 DOI: 10.1136/bmjopen-2017-019026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 02/15/2018] [Accepted: 02/19/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine whether there was an increased risk of perinatal mortality among mothers booked for care with community lead maternity carer (LMC) midwives in their first compared with later years of practice. DESIGN Retrospective cohort study using linked national maternity, mortality and workforce data; adjusted analysis using logistic regression. SETTING New Zealand. PARTICIPANTS Women under community LMC midwifery care birthing 2008-2014. MAIN OUTCOME MEASURES Perinatal mortality (stillbirths and neonatal deaths of babies born from 20 weeks' gestation to the 27th day of postnatal life), excluding terminations and deaths associated with congenital abnormalities. RESULTS There were 2045 deaths among 344 910 births booked with midwives.First year of practice midwives cared for women with higher risk of perinatal mortality, including Māori, Pacific, Indian, <20-year-old mothers, nullipara, smokers, women living in socioeconomic deprivation and with high body mass index, than midwives beyond first year of practice.There was a significant reduction in unadjusted odds of perinatal mortality among women under the care of midwives beyond the first year compared with those within the first year (OR 0.79, 95% CI 0.67 to 0.93) but no significant reduction in risk remained after adjusting for known risk factors, (OR 0.89, 95% CI 0.74 to 1.07).There was a significant increase in the adjusted odds of perinatal mortality among midwives booking a caseload of 15 or fewer mothers per year (1.34, 1.01 to 1.78) and 16 to 30 (1.25, 1.04 to 1.50) compared with midwives booking 51 to 80. CONCLUSIONS Findings suggest that the first year of midwifery practice is not associated with an increased risk of perinatal mortality but there is evidence that early career midwives are caring for higher-risk women. These findings suggest inequity of access for higher-risk women to experienced midwives and highlight an opportunity to improve support for vulnerable women and new midwives.
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Affiliation(s)
- Lynn C Sadler
- Women's Health, Auckland District Health Board, Auckland, New Zealand
- Department of Epidemiology and Biostatistics, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Judith McAra-Couper
- Midwifery Department, Auckland University of Technology, Auckland, New Zealand
| | - Deborah Pittam
- Maternity Services, Northland District Health Board, Whangarei, New Zealand
- New Zealand College of Midwives, Christchurch, New Zealand
| | - Michelle R Wise
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - John M D Thompson
- Departments of Paediatrics, Child and Youth Health, and Obstetrics and Gynaecology, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
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Edqvist M, Rådestad I, Lundgren I, Mollberg M, Lindgren H. Practices used by midwives during the second stage of labor to facilitate birth - Are they related to perineal trauma? SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 15:18-22. [PMID: 29389495 DOI: 10.1016/j.srhc.2017.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 11/01/2017] [Accepted: 11/09/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Malin Edqvist
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden, Arvid Wallgrens backe hus 1, Box (PO) 457, 405 30 Gothenburg, Sweden.
| | - Ingela Rådestad
- Sophiahemmet University, Box (PO) 5605, 114 86 Stockholm, Sweden.
| | - Ingela Lundgren
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden, Arvid Wallgrens backe hus 1, Box (PO) 457, 405 30 Gothenburg, Sweden.
| | - Margareta Mollberg
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden, Arvid Wallgrens backe hus 1, Box (PO) 457, 405 30 Gothenburg, Sweden.
| | - Helena Lindgren
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden, Arvid Wallgrens backe hus 1, Box (PO) 457, 405 30 Gothenburg, Sweden; Department of Women's and Children's Health, Karolinska Institute, Retzius väg 13 A-B, 171 77 Stockholm, Sweden.
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Halperin O, Noble A, Balachsan S, Klug E, Liebergall-Wischnitzer M. Association between severities of striae gravidarum and Obstetric Anal Sphincter Injuries (OASIS). Midwifery 2017; 54:25-28. [DOI: 10.1016/j.midw.2017.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/05/2017] [Accepted: 07/31/2017] [Indexed: 11/25/2022]
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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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