Lore De Meutter1, Antonine D van Heesewijk2, Ien van der Woerdt-Eltink3, Jan Willem de Leeuw2. 1. Ikazia Ziekenhuis, Dept. of Obstetrics and Gynaecology, Rotterdam, the Netherlands. Electronic address: l.de.meutter@ikazia.nl. 2. Ikazia Ziekenhuis, Dept. of Obstetrics and Gynaecology, Rotterdam, the Netherlands. 3. Rotterdam University of Applied Sciences, Master Physician Assistant-Clinical Midwife, the Netherlands.
Abstract
OBJECTIVE: Obstetric anal sphincter injury (OASI) is a serious complication of a vaginal delivery. In 2005, a Norwegian nation-wide training programme to reduce the OASI rate was successfully implemented. The aim of the present study was to assess the impact of a perineal support programme, inspired by the Norwegian programme, on the incidence of OASIs in a Dutch hospital with a low a priori rate. STUDY DESIGN: Prospective cohort study with historical comparison group. Three midwives and one obstetrician were trained on site by an expert midwife from Norway. These four trained the rest of the obstetrical staff. Data were prospectively recorded using the Dutch National Perinatal Registry, with additional recording whether the manual perineal support was actually applied in individual deliveries. OASI rates in three time periods were studied: the year preceding the training programme, the training period of 7 months and the year after the training period (respectively "control period", "training period" and "result period"). After exclusion of caesarean sections, preterm deliveries, breech and twin deliveries, a total of 4391 deliveries were recorded during the study period. RESULTS: During the training period, the OASI rate decreased significantly from 2.0 to 0.7% (aOR 0.34; 95%CI 0.15-0.76). In the result period, manual perineal support was performed in 72.7% of the deliveries and the overall OASI rate raised to 1.7% again, mainly because of non-compliance to the programme during vacuum deliveries. Nevertheless, multivariate logistic regression analysis with correction for known OASI risk factors showed that the OASI rate was 83% lower with application of perineal support (aOR 0.17; 95%CI 0.07-0.39). CONCLUSION: A perineal support programme decreases OASI rate. Continuous verification of application and repetitive training is necessary, especially during vacuum deliveries.
OBJECTIVE: Obstetric anal sphincter injury (OASI) is a serious complication of a vaginal delivery. In 2005, a Norwegian nation-wide training programme to reduce the OASI rate was successfully implemented. The aim of the present study was to assess the impact of a perineal support programme, inspired by the Norwegian programme, on the incidence of OASIs in a Dutch hospital with a low a priori rate. STUDY DESIGN: Prospective cohort study with historical comparison group. Three midwives and one obstetrician were trained on site by an expert midwife from Norway. These four trained the rest of the obstetrical staff. Data were prospectively recorded using the Dutch National Perinatal Registry, with additional recording whether the manual perineal support was actually applied in individual deliveries. OASI rates in three time periods were studied: the year preceding the training programme, the training period of 7 months and the year after the training period (respectively "control period", "training period" and "result period"). After exclusion of caesarean sections, preterm deliveries, breech and twin deliveries, a total of 4391 deliveries were recorded during the study period. RESULTS: During the training period, the OASI rate decreased significantly from 2.0 to 0.7% (aOR 0.34; 95%CI 0.15-0.76). In the result period, manual perineal support was performed in 72.7% of the deliveries and the overall OASI rate raised to 1.7% again, mainly because of non-compliance to the programme during vacuum deliveries. Nevertheless, multivariate logistic regression analysis with correction for known OASI risk factors showed that the OASI rate was 83% lower with application of perineal support (aOR 0.17; 95%CI 0.07-0.39). CONCLUSION: A perineal support programme decreases OASI rate. Continuous verification of application and repetitive training is necessary, especially during vacuum deliveries.
Authors: Posy Bidwell; Nick Sevdalis; Louise Silverton; James Harris; Ipek Gurol-Urganci; Alexandra Hellyer; Robert Freeman; Jan van der Meulen; Ranee Thakar Journal: Int Urogynecol J Date: 2021-01-21 Impact factor: 2.894
Authors: Posy Bidwell; Ranee Thakar; Ipek Gurol-Urganci; James M Harris; Louise Silverton; Alexandra Hellyer; Robert Freeman; Edward Morris; Vivienne Novis; Nick Sevdalis Journal: BMJ Open Date: 2020-09-09 Impact factor: 2.692
Authors: I Gurol-Urganci; P Bidwell; N Sevdalis; L Silverton; V Novis; R Freeman; A Hellyer; J van der Meulen; R Thakar Journal: BJOG Date: 2020-08-09 Impact factor: 6.531