Frequency of anal sphincter rupture at delivery in Sweden and Finland ‐ result of difference in manual help to the baby's head

Pirhonen, Jouko; Grénman, Seija; Haadem, Knut; Gudmundsson, Sæmundur; Lindqvist, Pelle G.; Siihola, Sirpa; Erkkola, Risto; Maršál, Karel

doi:10.1034/j.1600-0412.1998.771005.x

Cited by 74 publications

(102 citation statements)

References 13 publications

(13 reference statements)

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“…Investigators from Scandinavia have shown that the delivery method has a significant influence on the rate of anal sphincter tear [13]. Our data do not support this explanation.…”

Section: Discussioncontrasting

confidence: 57%

Risk factors associated with anal sphincter tear difference among midwife, private obstetrician, and resident deliveries

2008

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To identify risk factors that account for the difference in anal sphincter tear (AST) among midwife, private obstetrician, and resident deliveries. We performed a retrospective review of our obstetrical database and used logistic regression analysis to identify risk factors for AST. The relationship between delivery technique and AST was evaluated by comparing AST increase between vaginal deliveries without and with an episiotomy among the three categories of providers. After adjusting for risk factors, private obstetricians (OR: 1.81, 95% CI: 1.27-2.56) and residents (OR: 1.60, 95% CI: 1.20-2.15) had a higher rate of AST during vaginal delivery than midwives. Episiotomy increased the odds of AST by four-fold for midwives, two-fold for private obstetricians, and eight-fold for residents. Although midwife and resident's delivery methods were associated with more AST, neither experienced this complication more frequently than private obstetricians. This suggests that midwives and residents probably misdiagnosed some AST.

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“…Investigators from Scandinavia have shown that the delivery method has a significant influence on the rate of anal sphincter tear [13]. Our data do not support this explanation.…”

Section: Discussioncontrasting

confidence: 57%

Risk factors associated with anal sphincter tear difference among midwife, private obstetrician, and resident deliveries

2008

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“…[Key words: Sphincter rupture; Primary sphincter repair; Anal incontinence; Anal manometry; Transanal ultrasonography] C linically detected anal sphincter tears usually occur in fewer than 3 percent (range, 0.3-6.0 percent) of vaginal deliveries. [1][2][3] The tears are treated by immediate surgical repair, but no peroperative distinction is usually made between the external anal sphincter (EAS) and the internal anal sphincter (IAS). Persistent anal incontinence following this procedure exceeds 40 percent in most studies (range, 20-60 percent).…”

mentioning

confidence: 99%

Anal Incontinence After Obstetric Sphincter Tears: Outcome of Anatomic Primary Repairs

Norderval

Öian

Revhaug

et al. 2005

Diseases of the Colon &Amp; Rectum

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“…In Norway, the OASIS rate has increased from <1% in the 1960s to 4.3% at the beginning of the past decade 16,17 . A similar increase has been noted in other European countries, with the exception of Finland where the OASIS rate has remained stable at less than 1% over the past 25 years 18,19 . It is considered that this increase is secondary to the increased incidence of instrumental deliveries, improved training for health professionals and changing maternal-fetal risk factors.…”

mentioning

confidence: 52%

Hands-on or hands-off the perineum at childbirth: A re-appraisal of the available evidence

Antonakou¹

2017

Eur J Midwifery

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Obstetric anal sphincter injuries (OASIS), or third-degree and fourth-degree perineal tears, represent a serious complication of vaginal birth. There are reports that OASIS is a risk factor for the development of anal incontinence [1][2][3][4] , with significantly worse bowel symptoms and anorectal function with the higher degree of OASIS 5,6 . In addition, the economic cost of anal incontinence management following OASIS has been estimated to be approximately £1625 per patient 7 or £78 million per annum in the United Kingdom alone 8 . The current UK based maternity practice at second stage of labour involves two techniques 9,10 : 1) 'hands-on', where one hand of the practitioner applies pressure on the fetal head while the other hand supports the perineum, 2) 'hands-poised', where the hands of the practitioner are poised, ready to apply light pressure on the fetal head to avoid rapid expulsion. Most often, however, this latter technique has been misinterpreted as a 'hands-off technique'.The Royal College of Midwives (RCM) in 2012, and in line with the NICE 2007 guidance on intrapartum care, has suggested that the available evidence is inconclusive as to whether the 'hands-on' technique reduces the incidence of severe perineal trauma , which have however received heavy criticism from later studies as to the validity of their results and the robustness of their study design and methodology 14,15 . In the United Kingdom the incidence of OASIS for primiparous women has been reported to have tripled from 1.8% to 5.9%, over a 12-year period 8 . In Norway, the OASIS rate has increased from <1% in the 1960s to 4.3% at the beginning of the past decade 16,17 . A similar increase has been noted in other European countries, with the exception of Finland where the OASIS rate has remained stable at less than 1% over the past 25 years 18,19 . It is considered that this increase is secondary to the increased incidence of instrumental deliveries, improved training for health professionals and changing maternal-fetal risk factors. Nevertheless, regardless of the above-mentioned factors, the low risk of OASIS in Finland is suggested to be due to the classic 'hands-on' technique of perineal support at birth 19,20 . This hypothesis was tested in Norway in two hospital-based studies (2010 and 2012) that showed a significant decrease of OASIS by 50-70% 1,16 . It is interesting that these two studies were commissioned by the Norwegian Board of Health in 2004 as part of the national strategy to reduce OASIS, since hospitals were heavily criticised for having a high OASIS rate of 4.5% in 2004, and were therefore required to implement programs to reduce this.Following these two studies 1,16 , there was a UK population-based study in 2016 that replicated the study design of the Norwegian studies 21 . This UK study showed that 'hands-on' the perineum during the crowning at second stage reduced the OASIS overall rates by 23% and the 3c third degree and 4th degree tears by 71%. In a recent metanalysis in 2015 of observational studies, ...

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Frequency of anal sphincter rupture at delivery in Sweden and Finland ‐ result of difference in manual help to the baby's head

Abstract: The difference in the incidence of anal sphincter rupture between Malmö, Sweden and Turku, Finland may be due to the difference in manual control of the baby's head when crowning.

Cited by 74 publications

References 13 publications

Risk factors associated with anal sphincter tear difference among midwife, private obstetrician, and resident deliveries

Risk factors associated with anal sphincter tear difference among midwife, private obstetrician, and resident deliveries

Anal Incontinence After Obstetric Sphincter Tears: Outcome of Anatomic Primary Repairs

Hands-on or hands-off the perineum at childbirth: A re-appraisal of the available evidence

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