Impact of a quality improvement project to reduce the rate of obstetric anal sphincter injury: a multicentre study with a stepped‐wedge design

Abstract

criterion. However, we acknowledged in the paper that other clinical, health system-related and sociodemographic issues could have been considered, but were beyond the scope of our study. We sought to make our methodology transparent, recognising that others might consider different criteria to define stillbirth preventability. For the paper, we describe the clinical conditions, rather than the technical ICD-10 designations, to make the results more understandable to clinicians reading the paper.Despite these nuances, we are confident thatthedatasupportourmainconclusions that the majority of stillbirths occurring in many low-resource settings are preventable withgenerally availableresources, and the most common medical conditions associated with stillbirth in these settings include a small-for-gestational-age fetus, pre-eclampsia, placental abruption and deaths occurring after admission to the hospital. Focusing on improving obstetric care for these conditions should result in a substantial reduction in stillbirths in many low-resource settings.

Authors’ reply re: OASI Care Bundle

“…We would like to thank Scamell and colleagues for their letter in response to our paper describing the results of the Obstetric Anal Sphincter Injury Care Bundle (OASI-CB) evaluation. 1,2 We have previously addressed most of the points raised in our response to an earlier critical review of the OASI-CB by two of the signatories of this letter. 3 First, Scamell and colleagues indicate that they are disappointed in the quality of the evidence that supports the components of the OASI-CB.…”