Anal sphincter tears at spontaneous delivery: a comparison of five hospitals in Norway.

Abstract:

OBJECTIVE:To analyze circumstances relating to severe anal sphincter tears occurring at spontaneous delivery, in view of reported differences in practice regarding manual perineal protection during delivery. DESIGN:Cohort study of midwife-conducted non-operative vaginal deliveries. SETTING:Five Norwegian hospitals with 12,438 consecutive deliveries during a 12-month period. METHODS:Data from 357 women sustaining third and fourth grade anal sphincter tears (2.9%) were analyzed. MAIN OUTCOME MEASURES:Different incidence of major perineal tears. RESULTS:Sphincter tear incidence varied significantly between the five hospitals, from 1.3 to 4.7% (p<0.001, RR=3.14 (CI: 2.38-5.56)). There was no significant difference between the five hospitals when other risk variables were compared. Use of oxytocin in the second phase of labor and of epidural analgesia was significantly more often applied in the hospital with the lowest rate of sphincter tears. The midwives' perception of having applied perineal support was not significantly different between the two hospitals with the highest and the lowest incidence of sphincter tear. CONCLUSION:The observed difference in incidence of sphincter tear between the hospitals remains unexplained, but could be due to different perineal protection handling techniques.

authors

Valbø A,Gjessing L,Herzog C,Goderstad JM,Laine K,Valset AM

doi

10.1080/00016340802460354

subject

Has Abstract

pub_date

2008-01-01 00:00:00

pages

1176-80

issue

11

eissn

0001-6349

issn

1600-0412

pii

904909515

journal_volume

87

pub_type

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