ArticleBMJ open2013
The impact of an intervention programme employing a hands-on technique to reduce the incidence of anal sphincter tears: interrupted time-series reanalysis.
Article in BMJ open, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.
- Effectiveness of education and training programmes to help clinicians assess and classify perineal tears: a systematic review.BMJ open · 2025Pooled it
- Midwives' approach to the prevention and repair of obstetric perineal trauma in Spain.Nursing open · 2024Observational
- Variability of clinical practice in the care of the second stage of labor among midwives in Spain.BMC nursing · 2024Article
- Which elements were significant in reducing obstetric anal sphincter injury? A prospective follow-up study.BMC pregnancy and childbirth · 2021Article
- Impact of animated instruction on tablets and hands-on training in applying bimanual perineal support on episiotomy rates: an intervention study.International urogynecology journal · 2019Article
- Obstetric Anal Sphincter Injuries (OASIs) in Israel: A Review of the Incidence and Risk Factors.Rambam Maimonides medical journal · 2017Review
- Fetal head size and effect of manual perineal protection.PloS one · 2017Article
- Obstetric anal sphincter injuries: review of anatomical factors and modifiable second stage interventions.International urogynecology journal · 2015Review
- A retrospective study on perineal lacerations in vaginal delivery and the individual performance of experienced mifwives.BMC pregnancy and childbirth · 2015Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo re-evaluate previously published findings from an uncontrolled before-after evaluation of an intervention programme to reduce the incidence of anal sphincter tears. A key component of the programme was the use of a hands-on technique where the birth attendant presses the neonate's head during the final stage of delivery while simultaneously supporting the woman's perineum with the other hand.
designInterrupted time-series analysis using segmented regression modelling.
settingObstetric departments of five Norwegian hospitals.
participantsAll women giving births vaginally in the study hospitals, 2002-2008.
methodsThe main data source was the Medical Birth Registry of Norway. We estimated the change in incidence of anal sphincter tears before and after implementation of the intervention in the five intervention hospitals, taking into account the trends in incidence before and after implementation.
main outcome measuresIncidence of anal sphincter tears and episiotomies.
resultsThere were 75 543 registered births at the five included hospitals. We found a 2% absolute reduction in incidence of anal sphincter tears associated with the hospital intervention programme, representing almost a halving in the number of women experiencing serious anal sphincter tears. This is a substantially smaller estimate than previously reported. However, it does represent a highly significant decrease in anal sphincter injuries. The programme was also associated with a significant increase in episiotomies.
conclusionsThe intervention programme was associated with a significant reduction in the incidence of obstetric anal sphincter tears. Still, the findings should be interpreted with caution as they seem to contradict the findings from randomised controlled studies of similar interventions.
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