Assoziation zwischen Geburtsverletzungen und der Einführung geburtshilflicher Observationsmaßnahmen: eine retrospektive Kohortenstudie

Abstract

The overall incidence of birth lacerations is high, with lacerations predominantly appearing as first- and second-degree perineal tears but also vaginal and labial lacerations. The initiation of different obstetrical monitoring tools is associated with a change in the incidence of birth traumas and a shift from an external to an internal distribution, probably due to more careful management by the obstetrical staff. The implementation of such tools might help to improve obstetrical management and laboring women might benefit. However, it is important to realize the effect of monitoring and observation itself on the course of observational studies.

Reducing birth trauma by the implementation of novel monitoring and documentation tools

“…For this, we designed a detailed checklist with different items regarding the birth process, which is used for every single birth in our clinic. 4 These items include the persons present at birth and their communication with each other, the in-room atmosphere, maternal birth position, medical procedures performed, perineal support given, the act of giving birth itself, the exact position of the head and shoulders of the baby in the birth canal.…”

“…In our clinic, we designed a three-dimensional graph of the genital tract (Figure 1), where the birth attendant draws all sustained tears of a woman after birth. 4 Thus, we are able to get detailed information about the incidence, distribution and extent of all kind of birth tears (not only highgrade perineal tears). In addition, the graph helps staff on the childbed ward or the follow-up caregivers, for example to locate the tears in cases of complications with sutures or wound-healing.…”

“…In a retrospective cohort study, we evaluated the association of the implementation of our birth checklist, our tear graph and video recording in our labor ward with the incidence and distribution of different types of birth tears before and after the implementation of the tools. 4 The incidence of all types of birth trauma decreased, with a decrease in perineal and vulvar/labial lacerations but an increase in vaginal lacerations. The rate of episiotomies and third-and fourth-degree perineal With video recording, we found frequent notable omissions during vaginal births, for example inappropriate aseptic technique, improper fetal head slowdown during expulsion, lack of visualization of the perineum during fetal extraction/expulsion, lack of hip, shoulder and arm guiding while extracting the fetus, inappropriate episiotomy and vacuum technique.…”