Which elements were significant in reducing obstetric anal sphincter injury? A prospective follow-up study

Abstract Background To examine which elements of an obstetric anal sphincter injury (OASI) care bundle were protective for OASI. Several interventional trials showed that application of a care bundle involving a hands-on approach to perineal protection may reduce the risk of OASI. Previously, we fou...

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Autores principales:	Ole Bredahl Rasmussen, Annika Yding, Charlotte Sander Andersen, Jane Boris, Finn Friis Lauszus
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Obstetrics Obstetrical anal sphincter injury Perineum Hands-on Hands-off Delivery Gynecology and obstetrics RG1-991
Acceso en línea:	https://doaj.org/article/a365bde966cb413d91a21eb69c3ca687
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spelling	oai:doaj.org-article:a365bde966cb413d91a21eb69c3ca6872021-11-21T12:32:47ZWhich elements were significant in reducing obstetric anal sphincter injury? A prospective follow-up study10.1186/s12884-021-04260-z1471-2393https://doaj.org/article/a365bde966cb413d91a21eb69c3ca6872021-11-01T00:00:00Zhttps://doi.org/10.1186/s12884-021-04260-zhttps://doaj.org/toc/1471-2393Abstract Background To examine which elements of an obstetric anal sphincter injury (OASI) care bundle were protective for OASI. Several interventional trials showed that application of a care bundle involving a hands-on approach to perineal protection may reduce the risk of OASI. Previously, we found that only the element “hand on the fetal head” in itself was protective, although the risk of a type 2 error was calculated to be 50%. Methods A prospective follow-up study in an obstetric department in Denmark with 3200 deliveries per year. We included a cohort of 10,383 women giving birth vaginally from gestational week 22 + 0 from 2016 through 2019. We documented on a person-level the five elements of the care bundle together with maternal and obstetrical characteristics. The elements were 1) communication, 2) visible perineum, 3) hand on fetal head, 4) perineal support and 5) certification. Regression analysis was used for analysis of associations. The primary outcome measure was OASI. Results The total rate of OASI in vaginally delivering women was 1.9%. The incidence was 3.2% in nulliparous women giving birth vaginally. The rate of cesarean section was 16.5% and for episiotomy 2.4%. The reduction in the incidence of OASI was sustained since 2013. Hand on the fetal head and perineal support both were protective factors for OASI. In case of a nulliparous woman with a neonate weighing 3500 g giving birth spontaneously, the relative risk (RR) for OASI was 0.50 (95% CI 0.49- 0.51) with use of hand on the fetal head together with perineal support against no use. Similarly, with a nulliparous woman giving birth to a neonate of 3500 g by vacuum extraction, the RR for OASI was 0.65 (95% CI 0.62-0.68) against no use. Conclusions Both hand on the fetal head and perineal support were associated with a reduced risk of OASI.Ole Bredahl RasmussenAnnika YdingCharlotte Sander AndersenJane BorisFinn Friis LauszusBMCarticleObstetricsObstetrical anal sphincter injuryPerineumHands-onHands-offDeliveryGynecology and obstetricsRG1-991ENBMC Pregnancy and Childbirth, Vol 21, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Obstetrics Obstetrical anal sphincter injury Perineum Hands-on Hands-off Delivery Gynecology and obstetrics RG1-991
spellingShingle	Obstetrics Obstetrical anal sphincter injury Perineum Hands-on Hands-off Delivery Gynecology and obstetrics RG1-991 Ole Bredahl Rasmussen Annika Yding Charlotte Sander Andersen Jane Boris Finn Friis Lauszus Which elements were significant in reducing obstetric anal sphincter injury? A prospective follow-up study
description	Abstract Background To examine which elements of an obstetric anal sphincter injury (OASI) care bundle were protective for OASI. Several interventional trials showed that application of a care bundle involving a hands-on approach to perineal protection may reduce the risk of OASI. Previously, we found that only the element “hand on the fetal head” in itself was protective, although the risk of a type 2 error was calculated to be 50%. Methods A prospective follow-up study in an obstetric department in Denmark with 3200 deliveries per year. We included a cohort of 10,383 women giving birth vaginally from gestational week 22 + 0 from 2016 through 2019. We documented on a person-level the five elements of the care bundle together with maternal and obstetrical characteristics. The elements were 1) communication, 2) visible perineum, 3) hand on fetal head, 4) perineal support and 5) certification. Regression analysis was used for analysis of associations. The primary outcome measure was OASI. Results The total rate of OASI in vaginally delivering women was 1.9%. The incidence was 3.2% in nulliparous women giving birth vaginally. The rate of cesarean section was 16.5% and for episiotomy 2.4%. The reduction in the incidence of OASI was sustained since 2013. Hand on the fetal head and perineal support both were protective factors for OASI. In case of a nulliparous woman with a neonate weighing 3500 g giving birth spontaneously, the relative risk (RR) for OASI was 0.50 (95% CI 0.49- 0.51) with use of hand on the fetal head together with perineal support against no use. Similarly, with a nulliparous woman giving birth to a neonate of 3500 g by vacuum extraction, the RR for OASI was 0.65 (95% CI 0.62-0.68) against no use. Conclusions Both hand on the fetal head and perineal support were associated with a reduced risk of OASI.
format	article
author	Ole Bredahl Rasmussen Annika Yding Charlotte Sander Andersen Jane Boris Finn Friis Lauszus
author_facet	Ole Bredahl Rasmussen Annika Yding Charlotte Sander Andersen Jane Boris Finn Friis Lauszus
author_sort	Ole Bredahl Rasmussen
title	Which elements were significant in reducing obstetric anal sphincter injury? A prospective follow-up study
title_short	Which elements were significant in reducing obstetric anal sphincter injury? A prospective follow-up study
title_full	Which elements were significant in reducing obstetric anal sphincter injury? A prospective follow-up study
title_fullStr	Which elements were significant in reducing obstetric anal sphincter injury? A prospective follow-up study
title_full_unstemmed	Which elements were significant in reducing obstetric anal sphincter injury? A prospective follow-up study
title_sort	which elements were significant in reducing obstetric anal sphincter injury? a prospective follow-up study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/a365bde966cb413d91a21eb69c3ca687
work_keys_str_mv	AT olebredahlrasmussen whichelementsweresignificantinreducingobstetricanalsphincterinjuryaprospectivefollowupstudy AT annikayding whichelementsweresignificantinreducingobstetricanalsphincterinjuryaprospectivefollowupstudy AT charlottesanderandersen whichelementsweresignificantinreducingobstetricanalsphincterinjuryaprospectivefollowupstudy AT janeboris whichelementsweresignificantinreducingobstetricanalsphincterinjuryaprospectivefollowupstudy AT finnfriislauszus whichelementsweresignificantinreducingobstetricanalsphincterinjuryaprospectivefollowupstudy
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Which elements were significant in reducing obstetric anal sphincter injury? A prospective follow-up study

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