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Multicenter Study
. 2021 Feb;128(3):584-592.
doi: 10.1111/1471-0528.16396. Epub 2020 Aug 9.

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

I Gurol-Urganci  1   2 , P Bidwell  2 , N Sevdalis  3 , L Silverton  4 , V Novis  2 , R Freeman  5 , A Hellyer  2   6 , J van der Meulen  1 , R Thakar  7
Affiliations
Multicenter Study

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

I Gurol-Urganci et al. BJOG. 2021 Feb.

Abstract

Objective: To evaluate the impact of a care bundle (antenatal information to women, manual perineal protection and mediolateral episiotomy when indicated) on obstetric anal sphincter injury (OASI) rates.

Design: Multicentre stepped-wedge cluster design.

Setting: Sixteen maternity units located in four regions across England, Scotland and Wales.

Population: Women with singleton live births between October 2016 and March 2018.

Methods: Stepwise region by region roll-out every 3 months starting January 2017. The four maternity units in a region started at the same time. Multi-level logistic regression was used to estimate the impact of the care bundle, adjusting for time trend and case-mix factors (age, ethnicity, body mass index, parity, birthweight and mode of birth).

Main outcome measures: Obstetric anal sphincter injury in singleton live vaginal births.

Results: A total of 55 060 singleton live vaginal births were included (79% spontaneous and 21% operative). Median maternal age was 30 years (interquartile range 26-34 years) and 46% of women were primiparous. The OASI rate decreased from 3.3% before to 3.0% after care bundle implementation (adjusted odds ratio 0.80, 95% CI 0.65-0.98, P = 0.03). There was no evidence that the effect of the care bundle differed according to parity (P = 0.77) or mode of birth (P = 0.31). There were no significant changes in caesarean section (P = 0.19) or episiotomy rates (P = 0.16) during the study period.

Conclusions: The implementation of this care bundle reduced OASI rates without affecting caesarean section rates or episiotomy use. These findings demonstrate its potential for reducing perineal trauma during childbirth.

Tweetable abstract: OASI Care Bundle reduced severe perineal tear rates without affecting caesarean section rates or episiotomy use.

Keywords: Obstetric anal sphincter injury; perineal tear; quality improvement.

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Figures

Figure 1
Figure 1
OASI Care Bundle components.
See this image and copyright information in PMC

Comment in

References

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