Perineal injury associated with hands on/hands poised and directed/undirected pushing: A retrospective cross-sectional study of non-operative vaginal births, 2011–2016

Lee, Nigel; Firmin, Meaghan; Gao, Yu; Kildea, Sue

doi:10.1016/j.ijnurstu.2018.04.002

Cited by 16 publications

(4 citation statements)

References 39 publications

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“…For example, ethnicity and BMI have been identified as predictive factors for OASI [25,36], but could not be included in our analysis. We did not have data for the style of pushing that the women adopted or OP position; factors that may influence perineal outcome [38]. Although the sample included in the study was large (2,908 women), 458 women were excluded prior to analysis due to missing data; this may have influenced the results obtained.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Predictors of obstetric anal sphincter injury during waterbirth: a secondary analysis of a prospective observational study

et al. 2019

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Introduction and Hypothesis: Obstetric Anal Sphincter Injury (OASI) during childbirth is associated with urino-genital pain and dysfunction. Waterbirth is a popular birth choice for women, but controversy remains around the risk of OASI during waterbirth. This study reports on the incidence of OASI, and factors associated with OASI, for a cohort of women who gave birth in water.Methods: This secondary analysis used prospectively collected data from 2,908 women who gave birth in water in the hospital setting. Incidence of OASI was calculated. Univariable and multivariable logistic regression analysis evaluated factors associated with OASI.Results: The incidence of OASI was 1.9% (95% CI 1.4, 2.4) for all women. In nulliparae it was higher (3.2%, 95% CI 2.3, 4.3), than for multiparae (0.9%, 95% CI 0.5, 1.4). In the multivariable analysis two variables were associated with OASI; multiparity was negatively associated with OASI (aOR 0.24, 95% CI 0.12, 0.50, p < 0.001), and birth weight was positively associated with OASI (aOR 1.001, 95% CI 1.000, 1.002, p = 0.02). A 'hands-on' technique was used during only 13% of births. Birth position supporting a flexible sacrum did not influence OASI risk. Conclusions:A low incidence of OASI was found for this cohort of women. The low proportion of midwives using a hands-on technique suggests that it may not be required in waterbirth.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Predictors of obstetric anal sphincter injury during waterbirth: a secondary analysis of a prospective observational study

et al. 2019

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“…Lee et al 17 estudaram retrospectivamente 26.393 gestantes australianas no termo, com feto de apresentação única, cefálica, que passaram por parto vaginal não operatório. Nestes partos os pesquisadores utilizaram combinações de empunhadura prática direcionada à mão, dirigida ou não dirigida.…”

Section: Resultsunclassified

“…Esta observação pode permitir várias interpretações, dentre elas de que a técnica hands-on não promove uma diferença tão importante quanto imaginado, mas também de que talvez ela não esteja sendo realizada da melhor maneira possível. Dois estudos 12,17 , com um total de quase 30 mil partos, concluíram que o uso da técnica hands-on diminuiu a prevalência de lacerações, mas quando estas aconteciam eram sempre do tipo mais grave, especialmente para as multíparas. Haveria algum tipo de complicação no trabalho de parto, ou alguma característica do bebê ou do assoalho pélvico para a qual a técnica hands-on seria contra indicada?…”

Section: Discussionunclassified

Hands-on durante o período expulsivo: herói ou vilão?

Lima¹,

Bueno²,

Nunes

et al. 2020

Rev Pesq Fisio

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INTRODUÇÃO: Apesar de todos os avanços das ciências da saúde, a abordagem durante o trabalho de parto segue ainda ponto de inúmeras controversas e pouco consenso baseado em evidência, dentre as quais técnicas com ou sem o uso das mãos durante o expulsivo, respectivamente hands-on e hands-off, tem ganho destaque na literatura. OBJETIVOS: investigar se o uso da técnica hands-on, em oposição à hands-off, é de fato benéfico às parturientes. MÉTODO: Revisão sistemática, nas bases de dados Pubmed, BVS, PEDro e Scielo, usando as palavras-chave birth, hands-on e hands-off isoladas ou combinadas, bem como suas variantes em português. Dados foram organizados por técnica, instrumento de medida e resultados. RESULTADOS: Dos 14 estudos que compuseram a presente revisão, apenas três foram ensaios controlados. Seis estudos apontaram a ocorrência de menos lesões quando a técnica hands-on foi utilizada, mas em todos os estudos controlados não houve diferença estatística significativa entre os resultados dos grupos. CONCLUSÃO: A técnica hands-on vem sendo utilizada ao redor do mundo, mas não há suficiente evidência de que ela de fato previna qualquer tipo de lesão obstétrica. Apesar de existirem ensaios controlados, o contraste dos resultados quanto à laceração entre os grupos controle e teste não é forte o suficiente para conclusões mais sólidas.

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“…However, third-and fourth-degree traumas cause significant problems in the postpartum period, 4,5 resulting in medium-to long-term health implications, such as bowel incontinence. [5][6][7][8][9] The prevalence of perineal trauma depends on several factors and can be associated with foetal and maternal conditions, to a normal birth on its own, and to the episiotomy, which can have an impact more severe than the spontaneous laceration. 4,10 The episiotomy is intentionally made by the healthcare professionals typically reaches the perineal transverse superficial muscle and the bulbocavernosus muscle.…”

Section: Introductionmentioning

confidence: 99%

Perineal outcomes and its associated variables of water births versus non-water births: a cross-sectional study

Camargo

Varela

Ferreira

et al. 2019

Rev. Bras. Saude Mater. Infant.

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Objectives: to describe the perineal outcomes of women who had delivered in water and out of water. Methods: a cross-sectional and quantitative study developed in a public hospital in Setúbal, Portugal. The population was of women who participated in the "Water Birth Project" in the period from 2011 to 2014, which gave birth in water and out of water. 104 women were selected according to established inclusion criteria. The groups were compared according to the following variables: demographics, obstetric information, delivery care and perineal outcomes. The data were analyzed in the Stata(r) software, with descriptive and bivariate statistics (chi-square and Fisher's test). Results: the medical records of 73 women who gave birth in water and 31 women who gave birth out of water were studied. Water deliveries were significantly associated with fewer perineal lacerations, lower rates of episiotomy, and shorter delivery time. Conclusions: the results of the study suggest that childbirth in water has a protective effect against severe third or fourth degree perineal tears, during fetal expulsion in water.

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Perineal injury associated with hands on/hands poised and directed/undirected pushing: A retrospective cross-sectional study of non-operative vaginal births, 2011–2016

Abstract: A hands poised/undirected approach could be utilised in strategies for the prevention of moderate and severe perineal injury.

Cited by 16 publications

References 39 publications

Predictors of obstetric anal sphincter injury during waterbirth: a secondary analysis of a prospective observational study

Predictors of obstetric anal sphincter injury during waterbirth: a secondary analysis of a prospective observational study

Hands-on durante o período expulsivo: herói ou vilão?

Perineal outcomes and its associated variables of water births versus non-water births: a cross-sectional study

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