Risk factors for obstetric anal sphincter injury after a successful multicentre interventional programme

Abstract

Objective To evaluate and compare the risk profile of sustaining obstetric anal sphincter injuries (OASIS) and associated risks in five risk groups (low to high), after the OASIS rate was reduced from 4.6% to 2.0% following an interventional programme. The main focus of the intervention was on manual assistance during the final part of second stage of labour.Design A multicentre interventional cohort study with before and after comparison.Setting Four Norwegian obstetric departments. after the intervention. Associations with obstetric risks for OASIS were largely unchanged after the intervention, including first vaginal delivery (OR 3.84; 95% CI 2.90-5.07), birthweight 4500 g (OR 4.42; 95% CI 2.68-7.27), forceps delivery (OR 3.54; 95% CI 1.99-6.29) and mediolateral episiotomy (OR 0.89; 95% CI 0.70-1.12). However, the highest reduction of OASIS, (65%), was observed in group 0 (low-risk) (OR 0.35; 95% CI 0.24-0.51), and a 57% (OR 0.43; 95% CI 0.35-0.52), 61% (OR 0.39; 95% CI 0.31-0.48), and 58% (OR 0.42; 95% CI 0.30-0.60) reduction in groups with one, two and three risk factors, respectively. No change was observed in the group with four risk factors.Conclusion After the intervention the most significant decrease of OASIS was observed in low-risk births, although the main risk factors for OASIS remained unchanged.Keywords Low-risk deliveries, manual assistance, obstetric anal sphincter injuries, risk factors.Please cite this paper as: Stedenfeldt M, Øian P, Gissler M, Blix E, Pirhonen J. Risk factors for obstetric anal sphincter injury after a successful multicentre interventional programme. BJOG 2014;121:83-91.

Perineal management techniques among midwives at five hospitals in New South Wales – A cross‐sectional survey

“…More free text comments were made about ‘chinning’ than any other technique; mostly around unfamiliarity with this method. The introduction of a combination of strategies, including ‘chinning’ to routine care at birth was associated with a significant drop in the OASI rate in Norway 16, 17, 18, 19. It is unclear whether ‘chinning’ by itself had any effect, or whether the decrease was driven by the other ‘hands on’ techniques, and/or by other strategies individually or in combination with each other.…”

“…Other strategies, including emphasis on selective mediolateral (as opposed to midline) episiotomy, good visualisation of the perineum at birth and communication with the mother regarding slow pushing, were also implemented. With OASI rates decreasing from 4–5 to 1–2%,16, 17, 18, 19 questions about the appropriateness of abandoning traditional perineal support practices have been raised.…”

Reduction of the use of antimicrobial drugs following the rapid detection of Streptococcus agalactiae in the vagina at delivery by real‐time PCR assay

“…& Authors' reply Sir, We acknowledge Mrs Plumb for her interest in our recently published BJOG article. 1 Our study demonstrated the ability of a rapid molecular test to detect Streptococcus agalactiae (GBS) in the vagina of women at delivery, so as to reduce the prescription of useless antimicrobial drugs, in comparison with the current strategy founded on the detection of GBS in the maternal vagina at 35-37 weeks of gestation. In a few cases (three from a total of 225 women), however, the new strategy was impaired by the time needed to perform the test because of the short time between admission and delivery, which resulted in an insufficient dose of amoxicillin (2 grams instead of 3 grams) being administered during labour.…”

“…In a few cases (three from a total of 225 women), however, the new strategy was impaired by the time needed to perform the test because of the short time between admission and delivery, which resulted in an insufficient dose of amoxicillin (2 grams instead of 3 grams) being administered during labour. 1 Concerning the additional data required by Mrs Plumb, the mean length of time between the admission of pregnant woman and delivery was 9 hours 30 minutes AE 9 hours 38 minutes. In 20 cases from 225 (0.09%), the result of the molecular test was available only after delivery (see figure 2 in the original article).…”

“…If wanted, we are delighted to assist with training and Sir, I read this article with interest. 1 We would like to ask the authors to provide information on the length of time between: 1 The pregnant woman's admission and when the swabs were taken;…”