ArticleBMC pregnancy and childbirth2021
Which elements were significant in reducing obstetric anal sphincter injury? A prospective follow-up study.
Article in BMC pregnancy and childbirth, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 17 citations in OpenAlex.
- Does the type of pushing at delivery influence pelvic floor function at 2 months postpartum? A pragmatic randomized trial-The EOLE study.Acta obstetricia et gynecologica Scandinavica · 2023Trial
- Short-Term and Long-Term Outcomes and Predictors of Complications Following Major Obstetric Anal Sphincter Injuries.International urogynecology journal · 2026Article
- Efficacy of perineal massage in second stage of labour for prevention of perineal trauma: a randomized controlled trial.Maternal health, neonatology and perinatology · 2026Article
- Secular Trends in Recurrent Obstetric Anal Sphincter Injuries among 297,190 Women in Norway: A Cohort Study.International urogynecology journal · 2026Article
- Prevention of obstetric anal sphincter injuries with perineal support and lateral episiotomy: A historical cohort study.Acta obstetricia et gynecologica Scandinavica · 2024Article
- Perianal Diseases in Pregnancy and After Childbirth: Frequency, Risk Factors, Impact on Women's Quality of Life and Treatment Methods.Frontiers in surgery · 2022Review
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Authors and funding
5 authors at 1 institution in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundTo examine which elements of an obstetric anal sphincter injury (OASI) care bundle were protective for OASI. Several interventional trials showed that application of a care bundle involving a hands-on approach to perineal protection may reduce the risk of OASI. Previously, we found that only the element "hand on the fetal head" in itself was protective, although the risk of a type 2 error was calculated to be 50%.
methodsA prospective follow-up study in an obstetric department in Denmark with 3200 deliveries per year. We included a cohort of 10,383 women giving birth vaginally from gestational week 22 + 0 from 2016 through 2019. We documented on a person-level the five elements of the care bundle together with maternal and obstetrical characteristics. The elements were 1) communication, 2) visible perineum, 3) hand on fetal head, 4) perineal support and 5) certification. Regression analysis was used for analysis of associations. The primary outcome measure was OASI.
resultsThe total rate of OASI in vaginally delivering women was 1.9%. The incidence was 3.2% in nulliparous women giving birth vaginally. The rate of cesarean section was 16.5% and for episiotomy 2.4%. The reduction in the incidence of OASI was sustained since 2013. Hand on the fetal head and perineal support both were protective factors for OASI. In case of a nulliparous woman with a neonate weighing 3500 g giving birth spontaneously, the relative risk (RR) for OASI was 0.50 (95% CI 0.49- 0.51) with use of hand on the fetal head together with perineal support against no use. Similarly, with a nulliparous woman giving birth to a neonate of 3500 g by vacuum extraction, the RR for OASI was 0.65 (95% CI 0.62-0.68) against no use.
conclusionsBoth hand on the fetal head and perineal support were associated with a reduced risk of OASI.
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