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Case Reports
. 2018 Oct;8(4):e289-e294.
doi: 10.1055/s-0038-1675352. Epub 2018 Oct 29.

Importance of Individual Elements for Perineal Protection in Childbirth: An Interventional, Prospective Trial

Ole Bredahl Rasmussen  1 , Annika Yding  1 , Finn Lauszus  1 , Charlotte Sander Andersen  1 , Jacob Anhøj  2 , Jane Boris  1
Affiliations
Case Reports

Importance of Individual Elements for Perineal Protection in Childbirth: An Interventional, Prospective Trial

Ole Bredahl Rasmussen et al. AJP Rep. 2018 Oct.

Abstract

Objective To analyze the association between each element of a hands-on intervention in childbirth and the incidence of obstetric anal sphincter injuries (OASIS). Study Design We conducted a prospective, interventional quality improvement project and implemented a care bundle with five elements at an obstetric department in Denmark with 3,000 deliveries annually. We aimed at reducing the incidence of OASIS. In the preintervention period, 355 vaginally delivering nulliparous women were included. Similarly, 1,622 nulliparous women were included in the intervention period. The association of each element with the outcome was estimated using a regression analysis. Results The incidence of OASIS went down from 7.0 to 3.4% among nulliparous women delivering vaginally ( p = 0.003; relative risk = 0.48; 95% confidence interval [CI]: 0.30-0.76). Number needed to treat was 28. Logistic regression analysis showed that using hand on the head of the child significantly reduced the risk of OASIS (odds ratio = 0.28; 95% CI: 0.14-0.58). Conclusion Using a quality improvement framework, we documented the individual elements of the intervention. Hand on the infant's head reduced the risk of OASIS.

Keywords: hands-on; obstetric anal sphincter injury; quality improvement; vaginal delivery.

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Conflict of interest statement

Conflict of Interest There is no conflict of interest.

Figures

Fig. 1
Fig. 1
Rate of OASIS per month in nulliparous women with a vaginal delivery before and after the start of the intervention. P-chart. Horizontal line showing the extended baseline from the preintervention period. Vertical line showing the start of the intervention period, Herning Regional Hospital, Denmark. OASIS, obstetric anal sphincter injury.
Fig. 2
Fig. 2
Association of individual elements for perineal protection on the risk of obstetric anal sphincter injuries (odds ratios and 95% CIs). Regression analysis with stepwise removal of nonsignificant elements. Herning Regional Hospital, Denmark. CIs, confidence intervals; OASIS, obstetric anal sphincter injury.
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