Reducing obstetric anal sphincter injuries using perineal support: our preliminary experience

Naidu, Madhu; Sultan, Abdul H.; Thakar, Ranee

doi:10.1007/s00192-016-3176-4

Cited by 46 publications

(37 citation statements)

References 27 publications

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“…Whether these data are applicable to countries with lower episiotomy rates such as the UK needs to be established. However, there is emerging evidence from a study in the UK that manual perineal support may reduce the risk of severe OASI [80].…”

Section: Perineal Protectionmentioning

confidence: 99%

Obstetric anal sphincter injuries: review of anatomical factors and modifiable second stage interventions

2015

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Section: Perineal Protectionmentioning

confidence: 99%

Obstetric anal sphincter injuries: review of anatomical factors and modifiable second stage interventions

2015

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“…Nevertheless, it is important to recognize that most of the randomized controlled trials (RCTs) that have evaluated the topic do not provide details about the technique used for perineal support or measures taken to ensure its standardization. Indeed, this is one of the major shortfalls of such RCTs compared with non‐randomized observational studies . Moreover, there is evidence from biomechanical studies that the accuracy of the performance of the different maneuvers, dependent on the type of MPP technique, is essential for its effectiveness.…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, this is one of the major shortfalls of such RCTs compared with non-randomized observational studies. 12,23,24 Moreover, there is evidence from biomechanical studies that the accuracy of the performance of the different maneuvers, dependent on the type of MPP technique, is essential for its ef- Two independent assessors extracted data, from these responses, using an a priori list of core requirements (Table 1) to determine the accuracy of the maneuver and determine the MPP technique described. Descriptions that included a mixture of maneuvers from both FMPP and VMPP or that did not fulfill the core requirements were considered a non-classifiable style.…”

Section: Introductionmentioning

confidence: 99%

Manual perineal protection: The know‐how and the know‐why

Kleprlikova

Kališ

Lučovnik

et al. 2019

Acta Obstet Gynecol Scand

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Manual perineal protection is an obstetric intervention to mitigate the risk of perineal trauma. There are two effective techniques (Finnish and Viennese) with minor but distinctive differences in between them. The main aim of this study was to explore clinicians’ knowledge about the manual perineal protection technique they use. The study took place in three maternity units that support manual perineal protection policy in three European countries (Czech Republic, Slovenia and the UK). Our study demonstrated that the majority of participants are aware of the concept of manual perineal protection. However, there were significant differences between staff responses regarding their views and experience with manual perineal protection in general. Less than 6% of respondents were able to provide an accurate account of the actual maneuvers they perform when manually protecting the perineum. Although this is not necessarily synonymous with suboptimal performance, it highlights the potential need to give more attention to the theory that underpins the technical skill in manual perineal protection training programs.

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“…6 Like in all Nordic countries, the hospital had a relatively low cesarean delivery rate of around 17%-18%, which remained at the same level throughout the 7-year study period. 6 Like in all Nordic countries, the hospital had a relatively low cesarean delivery rate of around 17%-18%, which remained at the same level throughout the 7-year study period.…”

Section: Discussionmentioning

confidence: 91%

Effects of an intervention program for reducing severe perineal trauma during the second stage of labor

Sveinsdottir

Gottfreðsdóttir

Vernhardsdottir

et al. 2018

Birth

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Background Obstetric anal sphincter injuries lead frequently to short‐ and long‐term consequences for the mother, including perineal pain, genital prolapse, and sexual problems. The aim of the study was to evaluate whether the implementation of an intervention program in the second stage of labor involving altered perineal support techniques reduced severe perineal trauma. Methods All women reaching the second stage of labor and giving birth vaginally to singleton babies at Landspítali University Hospital (comprising 76% of births in Iceland in 2013) were enrolled in a cohort study. Data were recorded retrospectively for 2008‐2010 and prospectively in 2012‐2014, for a total of 16 336 births. During 2011, an intervention program was implemented, involving all midwives and obstetricians working in the labor wards. Two professionals assessed and agreed on classification of every perineal tear. Results The prevalence of obstetric anal sphincter injuries decreased from 5.9% to 3.7% after the implementation (P < 0.001). Third‐degree tears decreased by 40%, and fourth‐degree tears decreased by 56% (P < 0.001). The prevalence of first‐degree tears increased from 25.8% to 33.1%, whereas second‐degree tears decreased from 44.7% to 36.6% between the before and after study periods. Severe perineal trauma was linked to birthweight, and this did not change despite the new intervention. Conclusions Active intervention to reduce perineal trauma was associated with an overall significant decrease in obstetric anal sphincter injuries. Good perineal visualization, manual perineal support, and controlled delivery of the fetal head were essential components for reducing perineal trauma.

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Reducing obstetric anal sphincter injuries using perineal support: our preliminary experience

Abstract: This interventional study showed that perineal support during vaginal delivery can reduce the risk of major OASIs. With sustained reinforcement of this intervention programme, we anticipate a further reduction in OASI rates.

Cited by 46 publications

References 27 publications

Obstetric anal sphincter injuries: review of anatomical factors and modifiable second stage interventions

Obstetric anal sphincter injuries: review of anatomical factors and modifiable second stage interventions

Manual perineal protection: The know‐how and the know‐why

Effects of an intervention program for reducing severe perineal trauma during the second stage of labor

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