Risk factors for obstetric anal sphincter injuries (OASIS) and the role of episiotomy: A retrospective series of 496 cases

Ferolin²,

BMC Pregnancy Childbirth

et al. 2020

Background: Evidenced-based practice is a key component of quality care. However, studies in the Philippines have identified gaps between evidence and actual maternity practices. This study aims to describe the practice of evidence-based intrapartum care and its associated factors, as well as exploring the perceptions of healthcare providers in a tertiary hospital in the Philippines. Methods: A mixed-methods study was conducted, which consisted of direct observation of intrapartum practices during the second and third stages, as well as semi-structured interviews and focus group discussions with care providers to determine their perceptions and reasoning behind decisions to perform episiotomy or fundal pressure. Univariate and multivariate logistic regression were used to analyse the relationship between observed practices and maternal, neonatal, and environmental factors. Qualitative data were parsed and categorised to identify themes related to the decision-making process. Results: A total of 170 deliveries were included. Recommended care, such as prophylactic use of oxytocin and controlled cord traction in the third stage, were applied in almost all the cases. However, harmful practices were also observed, such as intramuscular or intravenous oxytocin use in the second stage (14%) and lack of foetal heart rate monitoring (57%). Of primiparae, 92% received episiotomy and 31% of all deliveries received fundal pressure. Factors associated with the implementation of episiotomy included primipara (adjusted Odds Ratio [aOR] 62.3), duration of the second stage of more than 30 min (aOR 4.6), and assisted vaginal delivery (aOR 15.0). Factors associated with fundal pressure were primipara (aOR 3.0), augmentation with oxytocin (aOR 3.3), and assisted delivery (aOR 4.8). Healthcare providers believe that these practices can prevent laceration. The rate of obstetric anal sphincter injuries (OASIS) was 17%. Associated with OASIS were assisted delivery (aOR 6.0), baby weights of more than 3.5 kg (aOR 7.8), episiotomy (aOR 26.4), and fundal pressure (aOR 6.2). Conclusions: Our study found that potentially harmful practices are still conducted that contribute to the occurrence of OASIS. The perception of these practices is divergent with current evidence, and empirical knowledge has more influence. To improve practices the scientific evidence and its underlying basis should be understood among providers.

Section: Obstetric Anal and Sphincter Injuriessupporting

confidence: 90%

Evidence-based intrapartum practice and its associated factors at a tertiary teaching hospital in the Philippines, a descriptive mixed-methods study

Ferolin²,

BMC Pregnancy Childbirth

et al. 2020

“…However, our study has shown that OASIS prevalence among primipara was 28.4%, which is much higher than previous findings. This present study confirmed that birthweight more than 3500g, episiotomy, fundal pressure and instrumental delivery were significantly associated with the occurrence of OASIS, consistent with previous literature [33][34][35]. OASIS has both short-and long-term severe consequences, such as pain, infection, dyspareunia, sexual dysfunction and anal incontinence [36,37].…”

Section: Obstetric Anal and Sphincter Injuriessupporting

confidence: 92%

Evidence-based intrapartum practice and its associated factors at a tertiary teaching hospital in the Philippines, a descriptive mixed methods study.

Ferolin

et al. 2020

Preprint

Background Evidenced-based practice is one of the key components of quality care. However, previous studies have identified gaps between evidence and actual maternity practices in the Philippines. This study aims to describe practice of evidence-based intrapartum care and its associated factors, as well as exploring the perception of healthcare providers in a tertiary hospital in the Philippines. Methods A mix-methods study was conducted, which consisted of direct observation of intrapartum practices during the second and third stages; semi-structured interviews and focus group discussions with care providers to confirm the reasons to perform episiotomy or fundal pressure and their perception. Univariate and multivariate logistic regression were used to analyse the relationship between observed practices and maternal, neonatal and environmental factors. Qualitative data were extracted and categorised to identify themes related to the decision-making process of practices. Results A total of 170 deliveries were included. Recommended care, such as prophylactic use of oxytocin and controlled cord traction in the third stage, were applied in almost all the cases. However, harmful practices, such as intramuscular or intravenous oxytocin use in the second stage (14.1%) and lack of foetal heart rate monitoring (57.1%) were also observed. 92.0% of primiparas received episiotomy and 31.2% of all deliveries received fundal pressure. The following factors were associated with implementation of episiotomy; primipara (adjusted Odds Ratio [aOR] 62.3), duration of the second stage more than 30 minutes (aOR 4.6) and assisted vaginal delivery (aOR 15.0). Factors associated with fundal pressure were primipara (aOR 3.0), augmentation with oxytocin (aOR 3.3) and assisted vaginal delivery (aOR 4.8). Healthcare providers believe these practices can prevent laceration. Women who got obstetric anal sphincter injuries (OASIS) was 17.1% in this study. Assisted vaginal delivery (aOR 6.0), baby’s weight more than 3500g (aOR 7.8), episiotomy (aOR 26.4) and fundal pressure (aOR 6.2) were associated with OASIS. Conclusions Our study found potentially harmful practices were still conducted, contributing to the occurrence of OASIS. The perception of these practices was divergent with the current evidence, with empirical knowledge having more influence. Scientific evidence and its underlying basis should be understood among providers to improve practices.

“…However, our study has shown that OASIS prevalence among primipara was 28.4%, which is much higher than the previous findings. This present study confirmed that birthweight more than 3500g, episiotomy, fundal pressure and instrumental delivery were significantly associated with the occurrence of OASIS, consistent with previous literature [34][35][36]. OASIS has both short-and long-term severe consequences, such as pain, infection, dyspareunia, sexual dysfunction and anal incontinence [37,38].…”

Section: Obstetric Anal and Sphincter Injuriessupporting

confidence: 92%

Practice and its associated factors of evidence-based care during second and third stage of labour at tertiary teaching hospital in the Philippines, a descriptive mixed methods study

Ferolin

et al. 2019

Preprint

Background Evidence-based practice is one of key components of quality maternal care. However, previous studies have identified gaps between evidence and actual practices at maternity in the Philippines. This study aims to describe practice of evidence-base intrapartum care and its associated factors in a tertiary teaching hospital.Methods A mix-methods study was conducted, which consists of direct observation of intrapartum practices during the second and third stages; semi-structured interviews and focus group discussions with care providers to confirm the reasons to perform episiotomy or fundal pressure and their perception. Descriptive statistics, and univariate and multivariate logistic regressions were used to analyse the relationship between observed practices and maternal, neonatal and environmental factors. Qualitative data was extracted and categorised to identify themes on the decision-making process of practices.Results A total of 170 deliveries were included. Recommended care, such as prophylactic use of oxytocin and controlled cord traction in the third stage, were applied in almost all the cases. However, harmful practices, such as intramuscular or intravenous oxytocin use in the second stage (14.1%) and lack of foetal heart rate monitoring (57.1%) were also observed. 92.0% of primiparas received episiotomy and 31.2% of all deliveries received fundal pressure. Following factors were associated with implementation of episiotomy; primipara (adjusted Odds Ratio 62.3 [16.3-237.1]), duration of the second stage more than 30 minutes (aOR 4.6 [1.2-17.7]) and assisted vaginal delivery (aOR 15.0 [1.2-192.0]). Factors associated with fundal pressure were; primipara (aOR 3.0 [1.4-6.7]), augmentation with oxytocin (aOR 3.3 [1.5-7.0]) and assisted vaginal delivery (aOR 4.8 [1.3-18.0]). Healthcare providers believe these practices can prevent laceration or proceed delivery. 17.1% of women got OASIS in this study. Assisted vaginal delivery (aOR 6.0 [1.6-22.4]), baby’s weight more than 3500g (aOR 7.8 [1.7-36.6]), episiotomy (aOR 26.4 [2.3-299.0]) and fundal pressure (aOR 6.2 [2.1-18.2]) were associated with OASIS.Conclusions Our study found potentially harmful practices were still conducted and they contributed to the occurrence of OASIS. The perception of these practices was divergent with the current evidence, empirical knowledge had more influence. Scientific evidence and its underlying knowledge should be understood among providers to improve practices.