De Meutter Lore, D van Heesewijk Antonine, van der Woerdt-Eltink Ien, de Leeuw Jan Willem
Ikazia Ziekenhuis, Dept. of Obstetrics and Gynaecology, Rotterdam, the Netherlands.
Ikazia Ziekenhuis, Dept. of Obstetrics and Gynaecology, Rotterdam, the Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2018 Nov;230:119-123. doi: 10.1016/j.ejogrb.2018.09.021. Epub 2018 Sep 13.
Obstetric anal sphincter injury (OASI) is a serious complication of a vaginal delivery. In 2005, a Norwegian nation-wide training programme to reduce the OASI rate was successfully implemented. The aim of the present study was to assess the impact of a perineal support programme, inspired by the Norwegian programme, on the incidence of OASIs in a Dutch hospital with a low a priori rate.
Prospective cohort study with historical comparison group. Three midwives and one obstetrician were trained on site by an expert midwife from Norway. These four trained the rest of the obstetrical staff. Data were prospectively recorded using the Dutch National Perinatal Registry, with additional recording whether the manual perineal support was actually applied in individual deliveries. OASI rates in three time periods were studied: the year preceding the training programme, the training period of 7 months and the year after the training period (respectively "control period", "training period" and "result period"). After exclusion of caesarean sections, preterm deliveries, breech and twin deliveries, a total of 4391 deliveries were recorded during the study period.
During the training period, the OASI rate decreased significantly from 2.0 to 0.7% (aOR 0.34; 95%CI 0.15-0.76). In the result period, manual perineal support was performed in 72.7% of the deliveries and the overall OASI rate raised to 1.7% again, mainly because of non-compliance to the programme during vacuum deliveries. Nevertheless, multivariate logistic regression analysis with correction for known OASI risk factors showed that the OASI rate was 83% lower with application of perineal support (aOR 0.17; 95%CI 0.07-0.39).
A perineal support programme decreases OASI rate. Continuous verification of application and repetitive training is necessary, especially during vacuum deliveries.
产科肛门括约肌损伤（OASI）是阴道分娩的一种严重并发症。2005年，挪威成功实施了一项全国性的培训计划以降低OASI发生率。本研究的目的是评估受挪威计划启发的会阴支持计划对一家荷兰医院（该医院OASI发生率较低）OASI发生率的影响。
采用历史对照组的前瞻性队列研究。三名助产士和一名产科医生由来自挪威的专家助产士进行现场培训。这四人对其余产科工作人员进行培训。使用荷兰国家围产期登记处前瞻性记录数据，并额外记录在个体分娩中是否实际应用了手动会阴支持。研究了三个时间段的OASI发生率：培训计划前一年、7个月的培训期以及培训期后一年（分别为“对照期”、“培训期”和“结果期”）。排除剖宫产、早产、臀位和双胎分娩后，研究期间共记录了4391例分娩。
在培训期间，OASI发生率从2.0%显著降至0.7%（调整后比值比0.34；95%置信区间0.15 - 0.76）。在结果期，72.7%的分娩实施了手动会阴支持，总体OASI发生率再次升至1.7%，主要是因为在真空吸引分娩期间未遵守该计划。然而，对已知OASI风险因素进行校正的多因素逻辑回归分析表明，应用会阴支持时OASI发生率降低了83%（调整后比值比0.17；95%置信区间0.07 - 0.39）。
会阴支持计划可降低OASI发生率。需要持续核实应用情况并进行重复培训，尤其是在真空吸引分娩期间。
