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Enhancing recognition of obstetric anal sphincter injuries in six maternity units in Palestine: an interventional quality improvement study
OBJECTIVE: To explore the impact of a training intervention on obstetric anal sphincter injuries’ (OASIS) detection rate. DESIGN: Prospective quality improvement interventional study. SETTING: Six secondary and tertiary maternity units in Palestine. POPULATION: Women having singleton vaginal births...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6009514/ https://www.ncbi.nlm.nih.gov/pubmed/29921684 http://dx.doi.org/10.1136/bmjopen-2017-020983 |
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author | Ali-Masri, Hadil Hassan, Sahar Ismail, Khaled Zimmo, Kaled Zimmo, Mohammed Fosse, Erik Vikanes, Åse Laine, Katariina |
author_facet | Ali-Masri, Hadil Hassan, Sahar Ismail, Khaled Zimmo, Kaled Zimmo, Mohammed Fosse, Erik Vikanes, Åse Laine, Katariina |
author_sort | Ali-Masri, Hadil |
collection | PubMed |
description | OBJECTIVE: To explore the impact of a training intervention on obstetric anal sphincter injuries’ (OASIS) detection rate. DESIGN: Prospective quality improvement interventional study. SETTING: Six secondary and tertiary maternity units in Palestine. POPULATION: Women having singleton vaginal births ≥23 weeks’ gestation or babies weighing ≥500 g (n=22 922). Caesarean births (n=5431), multiple gestations (n=443) and vaginal births of unregistered perineum status (n=800) were excluded. INTERVENTIONS: Training programme for enhancing OASIS detection was conducted between 31 January and 31 December 2015. International experts delivered 2-day standardisation workshop teaching OASIS diagnosis and repair to each maternity unit. They also provided additional training to three research fellows employed in three of the maternity units. This was followed by 13-week period of data collection (phase 1). Research fellows then delivered training intervention over 15-week interval (phase 2), including theoretical teaching and ‘onsite’ training in perineal trauma assessment within the six maternity units. Finally, 13-week postintervention observation (phase 3) followed. PRIMARY OUTCOME MEASURE: OASIS rates were used as surrogate for OASIS recognition. OASIS rates were compared between different phases and between the two maternity unit groups (research fellow and non-research fellow based) using Pearson’s χ² test. RESULTS: A total 22 922 women were included. Among primiparous women, OASIS rate was higher in phase 2 (2.8%, p<0.001) and phase 3 (3.1%, p<0.001) than phase 1 (0.5%). However, no significant differences were detected in the rates of severe OASIS (third-degree 3c and fourth-degree tears) between phase 1 and 2 (0.5% vs 0.3%), because this would have required at least 103 women with severe OASIS to be included in each phase. Among parous women, OASIS rate was significantly higher in phase 2 (0.6%, p=0.002) but not in phase 3 (0.4%, p=0.071) compared with phase 1 (0.2%). Research fellows’ maternity units showed higher OASIS rates among primiparous women in phase 2 (3.6% vs 1.4%, p=0.001) and phase 3 (4.3% vs 0.8%, p<0.001) than non-research fellows’ maternity units. CONCLUSIONS: This work is basically an epidemiological study which has identified the prevalence of perineal lacerations and their severity on a large sample of women representative of an entire geographical ethnic region. The quality improvement intervention improved OASIS detection mainly in the research fellows’ maternity units. Regular mandatory national programmes in obstetric perineal trauma assessment and management by local champions are essential to mitigate the risk of missing significant degrees of trauma. |
format | Online Article Text |
id | pubmed-6009514 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-60095142018-06-25 Enhancing recognition of obstetric anal sphincter injuries in six maternity units in Palestine: an interventional quality improvement study Ali-Masri, Hadil Hassan, Sahar Ismail, Khaled Zimmo, Kaled Zimmo, Mohammed Fosse, Erik Vikanes, Åse Laine, Katariina BMJ Open Obstetrics and Gynaecology OBJECTIVE: To explore the impact of a training intervention on obstetric anal sphincter injuries’ (OASIS) detection rate. DESIGN: Prospective quality improvement interventional study. SETTING: Six secondary and tertiary maternity units in Palestine. POPULATION: Women having singleton vaginal births ≥23 weeks’ gestation or babies weighing ≥500 g (n=22 922). Caesarean births (n=5431), multiple gestations (n=443) and vaginal births of unregistered perineum status (n=800) were excluded. INTERVENTIONS: Training programme for enhancing OASIS detection was conducted between 31 January and 31 December 2015. International experts delivered 2-day standardisation workshop teaching OASIS diagnosis and repair to each maternity unit. They also provided additional training to three research fellows employed in three of the maternity units. This was followed by 13-week period of data collection (phase 1). Research fellows then delivered training intervention over 15-week interval (phase 2), including theoretical teaching and ‘onsite’ training in perineal trauma assessment within the six maternity units. Finally, 13-week postintervention observation (phase 3) followed. PRIMARY OUTCOME MEASURE: OASIS rates were used as surrogate for OASIS recognition. OASIS rates were compared between different phases and between the two maternity unit groups (research fellow and non-research fellow based) using Pearson’s χ² test. RESULTS: A total 22 922 women were included. Among primiparous women, OASIS rate was higher in phase 2 (2.8%, p<0.001) and phase 3 (3.1%, p<0.001) than phase 1 (0.5%). However, no significant differences were detected in the rates of severe OASIS (third-degree 3c and fourth-degree tears) between phase 1 and 2 (0.5% vs 0.3%), because this would have required at least 103 women with severe OASIS to be included in each phase. Among parous women, OASIS rate was significantly higher in phase 2 (0.6%, p=0.002) but not in phase 3 (0.4%, p=0.071) compared with phase 1 (0.2%). Research fellows’ maternity units showed higher OASIS rates among primiparous women in phase 2 (3.6% vs 1.4%, p=0.001) and phase 3 (4.3% vs 0.8%, p<0.001) than non-research fellows’ maternity units. CONCLUSIONS: This work is basically an epidemiological study which has identified the prevalence of perineal lacerations and their severity on a large sample of women representative of an entire geographical ethnic region. The quality improvement intervention improved OASIS detection mainly in the research fellows’ maternity units. Regular mandatory national programmes in obstetric perineal trauma assessment and management by local champions are essential to mitigate the risk of missing significant degrees of trauma. BMJ Publishing Group 2018-06-19 /pmc/articles/PMC6009514/ /pubmed/29921684 http://dx.doi.org/10.1136/bmjopen-2017-020983 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Obstetrics and Gynaecology Ali-Masri, Hadil Hassan, Sahar Ismail, Khaled Zimmo, Kaled Zimmo, Mohammed Fosse, Erik Vikanes, Åse Laine, Katariina Enhancing recognition of obstetric anal sphincter injuries in six maternity units in Palestine: an interventional quality improvement study |
title | Enhancing recognition of obstetric anal sphincter injuries in six maternity units in Palestine: an interventional quality improvement study |
title_full | Enhancing recognition of obstetric anal sphincter injuries in six maternity units in Palestine: an interventional quality improvement study |
title_fullStr | Enhancing recognition of obstetric anal sphincter injuries in six maternity units in Palestine: an interventional quality improvement study |
title_full_unstemmed | Enhancing recognition of obstetric anal sphincter injuries in six maternity units in Palestine: an interventional quality improvement study |
title_short | Enhancing recognition of obstetric anal sphincter injuries in six maternity units in Palestine: an interventional quality improvement study |
title_sort | enhancing recognition of obstetric anal sphincter injuries in six maternity units in palestine: an interventional quality improvement study |
topic | Obstetrics and Gynaecology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6009514/ https://www.ncbi.nlm.nih.gov/pubmed/29921684 http://dx.doi.org/10.1136/bmjopen-2017-020983 |
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