The effects of a severe perineal trauma prevention program in an Australian tertiary hospital

An observational study

Mary J Borrman, Deborah Davis, Alison Porteous, Boon Lim

Research output: Contribution to journalArticle

Abstract

Background: Severe perineal trauma during childbirth is associated with significant morbidity and rates internationally, are on the rise. Aims: To determine the impact of a prevention program on severe perineal trauma in a nulliparous population at a tertiary hospital in Australia. Methods: Routinely collected maternity data were used comparing outcomes in two time periods; two years before and two years after the introduction of the program. Categorical data were compared using the Chi Squared statistic and continuous data Student's t-test. Logistic regression examined the association between independent and dependent variables using unadjusted and adjusted odds ratios, with 95% confidence intervals and p -values with significance set at 0.05. The main outcome of interest is severe perineal trauma. Results: The proportion of women in this nulliparous population experiencing severe perineal trauma during vaginal birth decreased from 8.8% in the first time period to 5.6% in the second. Reductions were achieved in all modes of vaginal birth but were most pronounced in vacuum births. Rates of episiotomy increased between time periods and further analysis found that this was protective of severe perineal trauma in all modes of birth for women of Asian country of birth and only in forceps birth for non-Asian women. Factors found to contribute to severe perineal trauma in this population were Asian country of birth, neonatal weight ≥4000gm, forceps birth and maternal age. Conclusions: The prevention program is associated with reduced rates of severe perineal trauma. The challenge for the service is to maintain this positive change.

Original languageEnglish
Pages (from-to)1-6
Number of pages6
JournalAustralian journal of midwifery : professional journal of the Australian College of Midwives Incorporated
DOIs
Publication statusE-pub ahead of print - 17 Sep 2019

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Tertiary Care Centers
Observational Studies
Parturition
Wounds and Injuries
Surgical Instruments
Population
Episiotomy
Maternal Age
Vacuum
Birth Weight
Logistic Models
Odds Ratio
Demography
Confidence Intervals
Students
Morbidity

Cite this

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title = "The effects of a severe perineal trauma prevention program in an Australian tertiary hospital: An observational study",
abstract = "Background: Severe perineal trauma during childbirth is associated with significant morbidity and rates internationally, are on the rise. Aims: To determine the impact of a prevention program on severe perineal trauma in a nulliparous population at a tertiary hospital in Australia. Methods: Routinely collected maternity data were used comparing outcomes in two time periods; two years before and two years after the introduction of the program. Categorical data were compared using the Chi Squared statistic and continuous data Student's t-test. Logistic regression examined the association between independent and dependent variables using unadjusted and adjusted odds ratios, with 95{\%} confidence intervals and p -values with significance set at 0.05. The main outcome of interest is severe perineal trauma. Results: The proportion of women in this nulliparous population experiencing severe perineal trauma during vaginal birth decreased from 8.8{\%} in the first time period to 5.6{\%} in the second. Reductions were achieved in all modes of vaginal birth but were most pronounced in vacuum births. Rates of episiotomy increased between time periods and further analysis found that this was protective of severe perineal trauma in all modes of birth for women of Asian country of birth and only in forceps birth for non-Asian women. Factors found to contribute to severe perineal trauma in this population were Asian country of birth, neonatal weight ≥4000gm, forceps birth and maternal age. Conclusions: The prevention program is associated with reduced rates of severe perineal trauma. The challenge for the service is to maintain this positive change.",
keywords = "Episiotomy, Parturition, Patient care bundles, Perineum, Tertiary healthcare",
author = "Borrman, {Mary J} and Deborah Davis and Alison Porteous and Boon Lim",
note = "Crown Copyright {\circledC} 2019. Published by Elsevier Ltd. All rights reserved.",
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T1 - The effects of a severe perineal trauma prevention program in an Australian tertiary hospital

T2 - An observational study

AU - Borrman, Mary J

AU - Davis, Deborah

AU - Porteous, Alison

AU - Lim, Boon

N1 - Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.

PY - 2019/9/17

Y1 - 2019/9/17

N2 - Background: Severe perineal trauma during childbirth is associated with significant morbidity and rates internationally, are on the rise. Aims: To determine the impact of a prevention program on severe perineal trauma in a nulliparous population at a tertiary hospital in Australia. Methods: Routinely collected maternity data were used comparing outcomes in two time periods; two years before and two years after the introduction of the program. Categorical data were compared using the Chi Squared statistic and continuous data Student's t-test. Logistic regression examined the association between independent and dependent variables using unadjusted and adjusted odds ratios, with 95% confidence intervals and p -values with significance set at 0.05. The main outcome of interest is severe perineal trauma. Results: The proportion of women in this nulliparous population experiencing severe perineal trauma during vaginal birth decreased from 8.8% in the first time period to 5.6% in the second. Reductions were achieved in all modes of vaginal birth but were most pronounced in vacuum births. Rates of episiotomy increased between time periods and further analysis found that this was protective of severe perineal trauma in all modes of birth for women of Asian country of birth and only in forceps birth for non-Asian women. Factors found to contribute to severe perineal trauma in this population were Asian country of birth, neonatal weight ≥4000gm, forceps birth and maternal age. Conclusions: The prevention program is associated with reduced rates of severe perineal trauma. The challenge for the service is to maintain this positive change.

AB - Background: Severe perineal trauma during childbirth is associated with significant morbidity and rates internationally, are on the rise. Aims: To determine the impact of a prevention program on severe perineal trauma in a nulliparous population at a tertiary hospital in Australia. Methods: Routinely collected maternity data were used comparing outcomes in two time periods; two years before and two years after the introduction of the program. Categorical data were compared using the Chi Squared statistic and continuous data Student's t-test. Logistic regression examined the association between independent and dependent variables using unadjusted and adjusted odds ratios, with 95% confidence intervals and p -values with significance set at 0.05. The main outcome of interest is severe perineal trauma. Results: The proportion of women in this nulliparous population experiencing severe perineal trauma during vaginal birth decreased from 8.8% in the first time period to 5.6% in the second. Reductions were achieved in all modes of vaginal birth but were most pronounced in vacuum births. Rates of episiotomy increased between time periods and further analysis found that this was protective of severe perineal trauma in all modes of birth for women of Asian country of birth and only in forceps birth for non-Asian women. Factors found to contribute to severe perineal trauma in this population were Asian country of birth, neonatal weight ≥4000gm, forceps birth and maternal age. Conclusions: The prevention program is associated with reduced rates of severe perineal trauma. The challenge for the service is to maintain this positive change.

KW - Episiotomy

KW - Parturition

KW - Patient care bundles

KW - Perineum

KW - Tertiary healthcare

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JF - Australian journal of midwifery : professional journal of the Australian College of Midwives Incorporated

SN - 1871-5192

ER -