TY - JOUR
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 - 2020/7
Y1 - 2020/7
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
KW - Patient Care Bundles
KW - Tertiary Care Centers
KW - Obstetric Labor Complications/epidemiology
KW - Humans
KW - Risk Factors
KW - Lacerations/prevention & control
KW - Pregnancy
KW - Delivery, Obstetric/adverse effects
KW - Maternal Age
KW - Perineum/injuries
KW - Tertiary Healthcare/statistics & numerical data
KW - Adult
KW - Female
KW - Program Evaluation
KW - Australia
KW - Episiotomy/statistics & numerical data
UR - http://www.scopus.com/inward/record.url?scp=85072207112&partnerID=8YFLogxK
UR - http://www.mendeley.com/research/effects-severe-perineal-trauma-prevention-program-australian-tertiary-hospital-observational-study
U2 - 10.1016/j.wombi.2019.07.301
DO - 10.1016/j.wombi.2019.07.301
M3 - Article
C2 - 31537498
SN - 1871-5192
VL - 33
SP - 371
EP - 376
JO - Australian journal of midwifery : professional journal of the Australian College of Midwives Incorporated
JF - Australian journal of midwifery : professional journal of the Australian College of Midwives Incorporated
IS - 4
ER -