Document Detail

Decreasing the incidence of anal sphincter tears during delivery.
MedLine Citation:
PMID:  18448735     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To estimate if an interventional program causes a decrease in the frequency of anal sphincter ruptures. METHODS: A total of 12,369 vaginal deliveries between 2002 and March 2007 were enrolled in the interventional cohort study. Slowing the delivery of the infant's head and instructing the mother not to push while the head is delivered was the intervention. Data were analyzed in relation to occurrence of anal sphincter tears. RESULTS: The proportion of parturients with anal sphincter tears decreased significantly during the study period from 4.03% (285 of 7,069) to 1.17% (42 of 3,577) (P<.001). A similar decrease was observed for instrumental deliveries (from 16.26% to 4.90%; P<.001) and noninstrumental deliveries (from 2.70% to 0.72%; P<.001). Although the number of patients with fourth-degree anal sphincter ruptures from 2002 through 2004 was 10, 13, and 11 per year, respectively, there was just one fourth-degree anal sphincter rupture during the whole study period of 18 months (P<.001). The number of episiotomies increased from 13.9% (980 of 7,069) in the years 2002-2004, to 23.1% during the first 9 months of the intervention (416 of 1,776; P<.001), but decreased to 21.1% (381 of 1,801) during the last 9 months of the intervention. CONCLUSION: As a result of this intervention the number of anal sphincter ruptures was reduced from 4.03% to 1.17%. LEVEL OF EVIDENCE: II.
Katariina Laine; Tiina Pirhonen; Rune Rolland; Jouko Pirhonen
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  111     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-05-01     Completed Date:  2008-06-12     Revised Date:  2009-10-26    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1053-7     Citation Subset:  AIM; IM    
Department of Obstetrics and Gynecology, Oestfold Trust Hospital, Fredrikstad, Norway.
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MeSH Terms
Anal Canal / injuries*
Delivery, Obstetric / adverse effects*,  methods*
Lacerations / epidemiology*
Patient Education as Topic
Wounds and Injuries / prevention & control

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