Obstetric Trauma Clinical Trial
Official title:
Incidence of Obstetric Anal Sphincter Injuries After Training to Protect the Perineum
This is a retrospective cohort study. This two cohort study seeks to compare the incidence of obstetric anal sphincter injuries (OASIS) in two time periods, before and after an educational workshop for improved perineal support.
Perineal trauma during vaginal delivery is a major health issue associated with significant
morbidity. It has been associated with many long term sequelae, including urinary and fecal
incontinence. Specifically, third and fourth degree lacerations are known risk factors for
the development of fecal incontinence.
Due to their serious impact, third or fourth degree perineal tears are a commonly tracked
adverse event in obstetric care (Agency for Healthcare Research and Quality and Joint
Commission). As such, incidence data will soon be available to third-party payers and to the
public on the Internet. Moreover, functional impairment after perineal lacerations continues
to be a significant impetus for legal claims. Thus, reducing OASIS while preserving maternal
and fetal outcomes is an important goal in clinical obstetrics.
At the two TriHealth tertiary care institutions, the overall rate of OASIS is 3.5%. This is
comparable, but not superior, to published rates at other centers. In fact, the literature is
quite variable, with reported incidences ranging from 0.25-6%. Indeed, TriHealth has recently
set up a task force to reduce these injuries as part of recent endeavors for quality
improvement. Prevention is the first step in improving these complications.
This study seeks to decrease the incidence of obstetric and anal sphincter injuries that may
occur during the birthing process by bringing in a notable physician to review techniques
with the obstetrics residents to help avoid these injuries then observe the deliveries of the
women enrolled.
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