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

Edda Sveinsdóttir*, Helga Gottfredsdottir, Anna S. Vernhardsdottir, Gudny B. Tryggvadottir, Reynir T. Geirsson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)371-378
Number of pages8
JournalBirth
Volume46
Issue number2
DOIs
Publication statusPublished - Jun 2019

Bibliographical note

Funding text 1
Funding information The project was supported by grants from the Icelandic Ministry of Welfare and the Landspítali University Hospital Research Fund, (04052011/Tilv.16) Reykjavik, Iceland. Assistance in the initial phases of the implementation was provided by Groa Margret Jonsdottir, midwife, and quality control officer at the maternity section at Landspítali University Hospital; Gudrun Gardarsdottir, secretary of the Icelandic Birth Registration; and Ingibjörg Richter at the Landspítali University Hospital Data Management Unit assisted with data procurement.
Funding text 2
The project was supported by grants from the Icelandic Ministry of Welfare and the Landspítali University Hospital Research Fund (04052011/Tilv.16), Reykjavik, Iceland..

Publisher Copyright:
© 2018 Wiley Periodicals, Inc.

Other keywords

  • obstetric anal sphincter injuries
  • pregnancy complications
  • vaginal delivery

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