The increased incidence of obstetric anal sphincter rupture — An emerging trend in Finland

Räisänen, Sari; Vehviläinen‐Julkunen, Katri; Gissler, Mika; Heinonen, Seppo

doi:10.1016/j.ypmed.2009.10.005

Cited by 31 publications

(33 citation statements)

References 29 publications

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“…This rate of clinically recognised anal sphincter injuries falls within the wide range of figures reported elsewhere. In large population-based studies using birth registry or administrative hospital data, the incidence was 1.8% in Finland, 5 3.6-4.2% in Norway, Denmark, and Sweden, 1,2 and 4.5-5.4% in the USA. 20,35 It is known that the actual rate of anal sphincter lacerations is significantly higher than the reported rates.…”

Section: Comparison With Previous Literaturementioning

confidence: 99%

“…62 Our results -and those of other studies -demonstrate that changes in the main risk factors do not explain the observed increase in the rates of severe perineal tears. [1][2][3]5,35 However, there have been significant changes in the management of the second stage of labour in the last decade. In the 1990s, ventouse was advocated as 'the instrument of first choice' for instrumental vaginal delivery.…”

Section: Comparison With Previous Literaturementioning

confidence: 99%

“…Other reasons include increased awareness and training, which is likely to result in a better case detection and recording of obstetric injuries, and changes in the management of the second stage of labour. 1,5 The aim of this study was to describe the time trends in obstetric anal sphincter injuries in England, recorded in a large population-based database that includes all maternity admissions in the English National Health Service (NHS). We also investigated risk factors for these injuries and explored to what extent changes in these relevant risk factors and in obstetric practice were linked to the observed trends.…”

Section: Introductionmentioning

confidence: 99%

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Third‐ and fourth‐degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors

Gurol‐Urganci

Cromwell

Edozien

et al. 2013

BJOG

336

270

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Objective To describe the trends of severe perineal tears in England and to investigate to what extent the changes in related risk factors could explain the observed trends.Design A retrospective cohort study of singleton deliveries from a national administrative database.Setting The English National Health Service between 1 April 2000 and 31 March 2012.Population A cohort of 1 035 253 primiparous women who had a singleton, term, cephalic, vaginal birth.Methods Multivariable logistic regression was used to estimate the impact of financial year of birth (labelled by starting year), adjusting for major risk factors.Main outcome measure The rate of third-degree (anal sphincter is torn) or fourth-degree (anal sphincter as well as rectal mucosa are torn) perineal tears.Results The rate of reported third-or fourth-degree perineal tears tripled from 1.8 to 5.9% during the study period. The rate of episiotomy varied between 30 and 36%. An increasing proportion of ventouse deliveries (from 67.8 to 78.6%) and non-instrumental deliveries (from 15.1 to 19.1%) were assisted by an episiotomy. A higher risk of third-or fourth-degree perineal tears was associated with a maternal age above 25 years, instrumental delivery (forceps and ventouse), especially without episiotomy, Asian ethnicity, a more affluent socio-economic status, higher birthweight, and shoulder dystocia.Conclusions Changes in major risk factors are unlikely explanations for the observed increase in the rate of third-or fourth-degree tears. The improved recognition of tears following the implementation of a standardised classification of perineal tears is the most likely explanation.Keywords Episiotomy, instrumental delivery, severe perineal trauma, trends, vaginal delivery.

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Section: Comparison With Previous Literaturementioning

confidence: 99%

Section: Comparison With Previous Literaturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Third‐ and fourth‐degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors

Gurol‐Urganci

Cromwell

Edozien

et al. 2013

BJOG

336

270

View full text Add to dashboard Cite

show abstract

“…A European study revealed that 7% of institutional definitions of mediolateral episiotomy stated that the incision point is located 1 or 2 cm form the midline (27). Lateral episiotomy is a method generally used in Finland where the rate of severe perineal lacerations is the lowest among Nordic countries (10,(47)(48)(49). Whether this is due to the use of the lateral episiotomy, or due to other factors e.g.…”

Section: Lateral Episiotomy Technique and Risk Of Oasimentioning

confidence: 99%

Different episiotomy techniques, postpartum perineal pain, and blood loss: an observational study

2012

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“…Local and international population‐based studies consistently report increasing obstetric anal sphincter injury (OASI) rates 1, 2, 3. However, changes in maternal characteristics and in risk factor prevalence captured in population health datasets only minimally explain the increase,3, 4 and improved clinical ascertainment and/or documentation of OASI may be contributing 3.…”

Section: Introductionmentioning

confidence: 99%

Perineal management techniques among midwives at five hospitals in New South Wales – A cross‐sectional survey

Ampt

Vroome

Ford

2015

Aust NZ J Obst Gynaeco

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BackgroundMidwives are reported to have changed from ‘hands on’ to ‘hands poised or off’ approaches to birth at the same time as obstetric anal sphincter injuries (OASIs) are increasing. As perineal management details are not routinely collected, it is difficult to quantify practice.AimsTo determine which perineal protections techniques midwives prefer for low‐risk non‐water births; whether preference is associated with technique taught or with other characteristics; and whether midwives change preference according to clinical scenario.Materials and MethodsMidwives in Northern Sydney Local Health District (NSLHD) were surveyed during a 2‐week period in 2014. Multiple‐choice questions were used, with free text option. Descriptive analyses, chi‐square and McNemar tests were undertaken.ResultsOne hundred and eight midwives participated (response rate 76.7%). ‘Hands poised or off’ was preferred by 63.0% for a low‐risk birth. Current practice was associated with technique taught (P < 0.01). For scenarios with increased OASI risk midwives reported switching to ‘hands on’, with 83.4% employing ‘hands on’ whether there was concern about an impending OASI. There has been a shift over time from teaching ‘hands on’ to ‘hands poised or off’.ConclusionThe preferred technique for a low‐risk birth appears to have changed from ‘hands on’ to ‘hands poised or off’, but most midwives adopt ‘hands on’ in situations of high risk for OASI. Further research is needed to establish whether there is an association with the rising OASI rate and the change in preferred perineal management technique for a low‐risk birth.

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The increased incidence of obstetric anal sphincter rupture — An emerging trend in Finland

Cited by 31 publications

References 29 publications

Third‐ and fourth‐degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors

Third‐ and fourth‐degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors

Different episiotomy techniques, postpartum perineal pain, and blood loss: an observational study

Perineal management techniques among midwives at five hospitals in New South Wales – A cross‐sectional survey

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