A Multicenter Interventional Program to Reduce the Incidence of Anal Sphincter Tears
- 1 October 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Obstetrics & Gynecology
- Vol. 116 (4), 901-908
- https://doi.org/10.1097/aog.0b013e3181eda77a
Abstract
In Norway, we have experienced a gradual increase in the incidence of obstetric anal sphincter injuries from under 1% in the late 1960s to 4.3% in 2004. This study was aimed to assess whether an interventional program causes a decrease in the frequency of anal sphincter tears. In all, 40,152 vaginal deliveries between 2003 and 2009 were enrolled in the interventional cohort study from four Norwegian obstetric departments. The focus of the intervention was on manual assistance during the final part of the second stage of labor. Data were analyzed in relation to occurrence of obstetric anal sphincter tears. The proportion of parturients with anal sphincter tears decreased from 4-5% to 1-2% during the study period in all four hospitals (P<.001). The tears associated with both noninstrumental and instrumental deliveries decreased dramatically. The number of patients with grades 3 and 4 anal sphincter ruptures decreased significantly, and the reduction was most pronounced in grade 4 tears (-63.5%) and least in 3c tears (-47.5%) (both P<.001). The number of episiotomies increased in two hospitals but remained unchanged in the other two. The lowest proportion of tears at the end of the intervention (1.2% and 1.3%, respectively) was found in the two hospitals with an unchanged episiotomy rate. The multicenter intervention caused a highly significant decrease in obstetric anal sphincter injuries. II.Keywords
This publication has 21 references indexed in Scilit:
- Episiotomy in the United States: has anything changed?American Journal of Obstetrics and Gynecology, 2009
- Modified Ritgen’s Maneuver for Anal Sphincter Injury at DeliveryObstetrics & Gynecology, 2008
- Decreasing the Incidence of Anal Sphincter Tears During DeliveryObstetrics & Gynecology, 2008
- Mediolateral episiotomy reduces the risk for anal sphincter injury during operative vaginal deliveryBJOG: An International Journal of Obstetrics and Gynaecology, 2007
- Risk Factors for Obstetric Anal Sphincter Injury: A Prospective StudyBirth, 2006
- Does the angle of episiotomy affect the incidence of anal sphincter injury?*BJOG: An International Journal of Obstetrics and Gynaecology, 2006
- Midwifery Care Measures in the Second Stage of Labor and Reduction of Genital Tract Trauma at Birth: A Randomized TrialJournal of Midwifery & Women's Health, 2005
- Anal Incontinence After Obstetric Sphincter Tears: Outcome of Anatomic Primary RepairsDiseases of the Colon & Rectum, 2005
- Third and fourth degree perineal tearsActa Obstetricia et Gynecologica Scandinavica, 2001
- Benefits and Risks of EpisiotomyObstetrical & Gynecological Survey, 1995