The least expensive replica Van Cleefcuff bracelet Do not overlook from zroessgs viesoess's blog
Incidence of obstetric anal sphincter injuries after training to protect the perineum
The present study compares obstetric anal sphincter injury in a large university hospital in two time periods (2003 2005 and 2008 2010), before and after implementing a perineum protection training programme to midwives and physicians to reduce the incidence of obstetric anal sphincter injuries.
Incidence of obstetric anal sphincter injury in different subgroups of women defined by risk factors is presented.
The incidence of obstetric anal sphincter injury was reduced between the two time periods.
The incidence of obstetric anal sphincter injuries can be reduced by implementing improved delivery techniques. Such injuries may cause persistent disabling anal incontinence symptoms.
A significant and persisting reduction of incidence of obstetric anal sphincter injuries of 50% from the first study period to the second study period was obtained. Obstetric anal sphincter injuries (OASIS) may cause pain, discomfort and anal incontinence (AI).6 8
Risk factors for OASIS have been widely studied, with several hundred studies currently available in PubMed, assessing maternal, obstetric and foetal risk factors. Numerous factors have been investigated and focus has often been on factors that are not modifiable, such as maternal age, height, weight, ethnicity, foetal weight and head size. Most previous studies conclude that primiparity, large infant birth weight and instrumental delivery increase the risk of OASIS, but when exploring factors such as maternal age (young or advanced), ethnicity, epidural use and episiotomy, the results are conflicting.9 14 Risk factors unrelated to the delivering woman or the infant size, such as the accoucheurs' management of the second stage of delivery, have been less investigated.
The incidence of OASIS varies between countries and delivery units.2 5 ,15 A steadily increasing incidence of OASIS has been reported in the Nordic countries over the last decades,2 ,5 ,15 ,16 albeit still at a very low rate in Finland.2 Factors such as alterations in patient population over time (increasing maternal age, larger infants and increased use of instrumental delivery) have been studied, but such factors cannot alone explain the increasing incidence of OASIS.5 ,15
In 2004,fake calibre de cartier chronograph, the Norwegian National Board of Health criticised the delivery units for a high incidence of OASIS, at that time being 4.5% of vaginal deliveries, and required that hospitals should implement programmes to reduce the OASIS incidence. Programmes to introduce manual perineal protection in the second stage of delivery were implemented in many Norwegian hospitals, and a reduction in OASIS incidence was achieved.17 ,womens cartier tank replica,18 In the Obstetric Department at Oslo University Hospital, Ullevl, attempts to reduce the incidence of OASIS were developed in steps, starting in 2006 with more focus on the OASIS issue in clinical meetings, whereas practical training to improve protection of perineum during the second stage of delivery started in 2008. Such training programmes have previously been described in two studies.17 ,18
The primary aim of the present study was to compare the incidence of OASIS across two time periods, before and after implementing a training programme for perineal protection during second stage of delivery, aimed at reducing the incidence of OASIS. Two cohorts were chosen to the study, 2003 2005 and 2008 2010. Surgery notes for the perineum repair in the medical record for each case were carefully read, and false positive cases were excluded (n=22). In addition, patients with the diagnosis OASIS (ICD 10 code O70.2 or O70.3) were identified from the electronic hospital discharge register and 13 additional patients with OASIS were identified. After excluding women delivered with caesarean section, preterm deliveries (
Definition and diagnostics of OASIS
Obstetric anal sphincter injury was defined as any degree of injury in the anal sphincter muscle (3A, 3B,copy cartier ballon bleu gold, 3C and 4th degree perineal tears, identified by the diagnoses O70.2 and O70.3 in the ICD 10 system).19
In Norway, spontaneous deliveries are attended by midwives whereas instrumental deliveries are handled by physicians. To increase safety during delivery for both the mother and the infant,cartier santos watch fake, the procedure at our department requires at least two accoucheurs (two midwives or one midwife and a physician) attending the second and third stage of each delivery. If the midwife suspects OASIS, a physician attends the labour room and evaluates and classifies the degree of perineal tear. An intervention programme was implemented from 2008, including both midwives and physicians at the Department of Obstetrics and Gynaecology. An external midwife was hired in from another hospital (where a similar programme was previously successfully implemented) to educate a group of trainer midwives, who then further educated the entire midwife staff. Physicians (both registrars and specialists) were educated in the perineal supporting technique and supervised by KL. First part of the training included a practical hands on training on a pelvic delivery model and the second part included hands on supervision in labour room during the second stage of delivery. The perineum protection programme consisted of four components during the last part of second stage of delivery, when the baby's head is crowning: slowing the delivery of the baby's head with one hand, supporting perineum with the other hand and squeezing with fingers (first and second) from the perineum lateral parts towards the middle in order to lower the pressure in middle posterior perineum, and asking the delivering woman not to push. The fourth part of the intervention was education in correct performing of episiotomy. At our department, episiotomy is performed only when indicated, for example due to foetal distress or imminent severe perineal tear. The main focus of this intervention step was to avoid median cuts of episiotomy technique, when performed, due to the augmented risk of OASIS associated with median episiotomies.20
The present study compares obstetric anal sphincter injury in a large university hospital in two time periods (2003 2005 and 2008 2010), before and after implementing a perineum protection training programme to midwives and physicians to reduce the incidence of obstetric anal sphincter injuries.
Incidence of obstetric anal sphincter injury in different subgroups of women defined by risk factors is presented.
The incidence of obstetric anal sphincter injury was reduced between the two time periods.
The incidence of obstetric anal sphincter injuries can be reduced by implementing improved delivery techniques. Such injuries may cause persistent disabling anal incontinence symptoms.
A significant and persisting reduction of incidence of obstetric anal sphincter injuries of 50% from the first study period to the second study period was obtained. Obstetric anal sphincter injuries (OASIS) may cause pain, discomfort and anal incontinence (AI).6 8
Risk factors for OASIS have been widely studied, with several hundred studies currently available in PubMed, assessing maternal, obstetric and foetal risk factors. Numerous factors have been investigated and focus has often been on factors that are not modifiable, such as maternal age, height, weight, ethnicity, foetal weight and head size. Most previous studies conclude that primiparity, large infant birth weight and instrumental delivery increase the risk of OASIS, but when exploring factors such as maternal age (young or advanced), ethnicity, epidural use and episiotomy, the results are conflicting.9 14 Risk factors unrelated to the delivering woman or the infant size, such as the accoucheurs' management of the second stage of delivery, have been less investigated.
The incidence of OASIS varies between countries and delivery units.2 5 ,15 A steadily increasing incidence of OASIS has been reported in the Nordic countries over the last decades,2 ,5 ,15 ,16 albeit still at a very low rate in Finland.2 Factors such as alterations in patient population over time (increasing maternal age, larger infants and increased use of instrumental delivery) have been studied, but such factors cannot alone explain the increasing incidence of OASIS.5 ,15
In 2004,fake calibre de cartier chronograph, the Norwegian National Board of Health criticised the delivery units for a high incidence of OASIS, at that time being 4.5% of vaginal deliveries, and required that hospitals should implement programmes to reduce the OASIS incidence. Programmes to introduce manual perineal protection in the second stage of delivery were implemented in many Norwegian hospitals, and a reduction in OASIS incidence was achieved.17 ,womens cartier tank replica,18 In the Obstetric Department at Oslo University Hospital, Ullevl, attempts to reduce the incidence of OASIS were developed in steps, starting in 2006 with more focus on the OASIS issue in clinical meetings, whereas practical training to improve protection of perineum during the second stage of delivery started in 2008. Such training programmes have previously been described in two studies.17 ,18
The primary aim of the present study was to compare the incidence of OASIS across two time periods, before and after implementing a training programme for perineal protection during second stage of delivery, aimed at reducing the incidence of OASIS. Two cohorts were chosen to the study, 2003 2005 and 2008 2010. Surgery notes for the perineum repair in the medical record for each case were carefully read, and false positive cases were excluded (n=22). In addition, patients with the diagnosis OASIS (ICD 10 code O70.2 or O70.3) were identified from the electronic hospital discharge register and 13 additional patients with OASIS were identified. After excluding women delivered with caesarean section, preterm deliveries (
Definition and diagnostics of OASIS
Obstetric anal sphincter injury was defined as any degree of injury in the anal sphincter muscle (3A, 3B,copy cartier ballon bleu gold, 3C and 4th degree perineal tears, identified by the diagnoses O70.2 and O70.3 in the ICD 10 system).19
In Norway, spontaneous deliveries are attended by midwives whereas instrumental deliveries are handled by physicians. To increase safety during delivery for both the mother and the infant,cartier santos watch fake, the procedure at our department requires at least two accoucheurs (two midwives or one midwife and a physician) attending the second and third stage of each delivery. If the midwife suspects OASIS, a physician attends the labour room and evaluates and classifies the degree of perineal tear. An intervention programme was implemented from 2008, including both midwives and physicians at the Department of Obstetrics and Gynaecology. An external midwife was hired in from another hospital (where a similar programme was previously successfully implemented) to educate a group of trainer midwives, who then further educated the entire midwife staff. Physicians (both registrars and specialists) were educated in the perineal supporting technique and supervised by KL. First part of the training included a practical hands on training on a pelvic delivery model and the second part included hands on supervision in labour room during the second stage of delivery. The perineum protection programme consisted of four components during the last part of second stage of delivery, when the baby's head is crowning: slowing the delivery of the baby's head with one hand, supporting perineum with the other hand and squeezing with fingers (first and second) from the perineum lateral parts towards the middle in order to lower the pressure in middle posterior perineum, and asking the delivering woman not to push. The fourth part of the intervention was education in correct performing of episiotomy. At our department, episiotomy is performed only when indicated, for example due to foetal distress or imminent severe perineal tear. The main focus of this intervention step was to avoid median cuts of episiotomy technique, when performed, due to the augmented risk of OASIS associated with median episiotomies.20
The Wall