Abstract
BackgroundTo 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%.MethodsA 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.ResultsThe 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.ConclusionsBoth hand on the fetal head and perineal support were associated with a reduced risk of OASI.
Highlights
To examine which elements of an obstetric anal sphincter injury (OASI) care bundle were protective for OASI
Intervention The present follow-up study arose from a quality improvement project that began in June 2013 at the delivery ward in Herning Hospital, Denmark in which we successfully reduced the incidence of OASI from 7.0 to 3.4% in vaginally delivering nulliparous women [9]
Since it is not feasible to apply all elements of an OASI care bundle in all deliveries, we find it important to document the use of each element, especially when analysis is carried out for comparative reasons
Summary
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. Obstetric anal sphincter injury (OASI) is a serious complication of vaginal delivery. The severity of OASI is documented [1, 2] and confirmed by organizations representing women, such as “Mothers with Anal Sphincter Injuries in Childbirth” [3]. Several interventional trials show that application of a care bundle involving a hands-on approach to perineal protection may reduce the risk of OASI [5,6,7,8,9,10,11]. The specific use of manual perineal protection is documented and a protective effect found [15]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
