Kaled Mikki Zimmo1,2,3, Katariina Laine4,5, Erik Fosse6,7, Mohammed Zimmo6,7,8, Hadil Ali-Masri6,7,9, Bettina Böttcher10, Manuela Zucknick11, Åse Vikanes6, Sahar Hassan12. 1. Department of Obstetrics, Al Aqsa Hospital, Gaza, Palestine. drkaledzimmo@gmail.com. 2. The Intervention Centre, Oslo University Hospital, Rikshospitalet, 4950 Nydalen, 0424, Oslo, Norway. drkaledzimmo@gmail.com. 3. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. drkaledzimmo@gmail.com. 4. Department of Health Management and Health Economics, Institute for Health and Society, University of Oslo, Oslo, Norway. 5. Department of Obstetrics, Oslo University Hospital, Ullevål, Oslo, Norway. 6. The Intervention Centre, Oslo University Hospital, Rikshospitalet, 4950 Nydalen, 0424, Oslo, Norway. 7. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. 8. Department of Obstetrics, Al Shifa Hospital, Gaza, Palestine. 9. Department of Obstetrics, Palestine Medical Complex, Ramallah, Palestine. 10. Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine. 11. Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway. 12. Departement of Nursing, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, Palestine.
Abstract
INTRODUCTION AND HYPOTHESIS: In Palestine, episiotomy is frequently used among primiparous women.This study assesses the effect of training birth attendants in applying bimanual perineal support during delivery by either animated instruction on tablets or hands-on training on episiotomy rates among primiparous women. METHODS: An interventional cohort study was performed from 15 October 2015 to 31 January 2017, including all primiparous women with singletons and noninstrumental vaginal deliveries at six Palestinian hospitals. Intervention 1 (animated instructions on tablets) was conducted in Hospitals 1, 2, 3, and 4. Intervention 2 (bedside hands-on training) was applied in Hospitals 1 and 2 only. Hospitals 5 and 6 did not receive interventions. Differences in episiotomy rates in intervention and nonintervention hospitals were assessed before and after the interventions and presented as p values using chi-square test, and odds ratios (OR) with 95% confidence intervals (CI). Differences in the demographic and obstetric characteristics were presented as p values using the Kruskal-Wallis test. RESULTS: Of 46,709 women, 12,841 were included. The overall episiotomy rate in the intervention hospitals did not change significantly after intervention 1, from 63.1 to 62.1% (OR = 0.96, 95% CI 0.84-1.08), but did so after intervention 2, from 61.1 to 38.1% (OR = 0.39, 95% CI 0.33-0.47). Rates after Intervention 2 changed from 65.0 to 47.3% (OR = 0.52, 95% CI 0.40-0.67) in Hospital 1 and from 39.4 to 25.1% (OR = 0.49, 95% CI 0.35-0.68) in Hospital 2. CONCLUSIONS: Hands-on training of bimanual perineal support during delivery of primiparous women was significantly more effective in reducing episiotomy rates than animated instruction videos alone.
INTRODUCTION AND HYPOTHESIS: In Palestine, episiotomy is frequently used among primiparous women.This study assesses the effect of training birth attendants in applying bimanual perineal support during delivery by either animated instruction on tablets or hands-on training on episiotomy rates among primiparous women. METHODS: An interventional cohort study was performed from 15 October 2015 to 31 January 2017, including all primiparous women with singletons and noninstrumental vaginal deliveries at six Palestinian hospitals. Intervention 1 (animated instructions on tablets) was conducted in Hospitals 1, 2, 3, and 4. Intervention 2 (bedside hands-on training) was applied in Hospitals 1 and 2 only. Hospitals 5 and 6 did not receive interventions. Differences in episiotomy rates in intervention and nonintervention hospitals were assessed before and after the interventions and presented as p values using chi-square test, and odds ratios (OR) with 95% confidence intervals (CI). Differences in the demographic and obstetric characteristics were presented as p values using the Kruskal-Wallis test. RESULTS: Of 46,709 women, 12,841 were included. The overall episiotomy rate in the intervention hospitals did not change significantly after intervention 1, from 63.1 to 62.1% (OR = 0.96, 95% CI 0.84-1.08), but did so after intervention 2, from 61.1 to 38.1% (OR = 0.39, 95% CI 0.33-0.47). Rates after Intervention 2 changed from 65.0 to 47.3% (OR = 0.52, 95% CI 0.40-0.67) in Hospital 1 and from 39.4 to 25.1% (OR = 0.49, 95% CI 0.35-0.68) in Hospital 2. CONCLUSIONS: Hands-on training of bimanual perineal support during delivery of primiparous women was significantly more effective in reducing episiotomy rates than animated instruction videos alone.
Authors: Elisabeth Hals; Pål Øian; Tiina Pirhonen; Mika Gissler; Sissel Hjelle; Elisabeth Berge Nilsen; Anne Mette Severinsen; Cathrine Solsletten; Tom Hartgill; Jouko Pirhonen Journal: Obstet Gynecol Date: 2010-10 Impact factor: 7.661
Authors: Hadil Y Ali; Åse Vikanes; Marit Anti; Sahar Hassan; Khaled M Ismail; Kaled Zimmo; Mohammed Zimmo; Erik Fosse; Katariina Laine Journal: Int J Gynaecol Obstet Date: 2017-02-27 Impact factor: 3.561