Department of Surgery, St. Joseph's University Medical Center, Paterson, NJ, USA.
Divisions of Family Planning, Department of Obstetrics & Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Int Urogynecol J. 2020 Mar;31(3):591-604. doi: 10.1007/s00192-019-03897-x. Epub 2019 Mar 15.
There are no data on midwives' knowledge and management of obstetric anal sphincter injuries (OASIs) in the USA. We performed a cross-sectional national survey characterizing OASI practice by certified nurse midwives (CNMs), hypothesizing that few midwives personally repair OASIs and that there are gaps in CNM OASI training/education.
We emailed a REDCap internet-based survey to 6909 American College of Nurse Midwives members (ACNM). We analyzed responses from active clinicians performing at least one delivery per month, asking about OASI risks, prevention, repair, and management. We summarized descriptive data then evaluated OASI knowledge by patient and provider characteristics.
We received 1070 (15.5%) completed surveys, and 832 (77.8%) met the inclusion/exclusion criteria. Participants were similar to ACNM membership. Respondents most frequently identified prior OASI (87%) and nutrition (71%) as antepartum OASI risk factors and, less frequently, nulliparity (36%) and race (22%). Identified intrapartum risks included forceps delivery (94%) and midline episiotomy (88%). When obstetric laceration is suspected, 13.6% of respondents perform a rectal examination routinely. Only 15% of participants personally perform OASI repair. Overall, participants matched 64% of evidence-based answers. OASI education/training courses were attended by 30% of respondents, and 44% knew of OASI protocols within their group/institution. Of all factors evaluated, the percent of evidence-based responses was only different for respondent education/CME and protocols.
Quality initiatives regarding OASI prevention and management may improve care. Our data suggest OASI training for midwives may improve delivery care in the US. Further studies of other obstetric providers are needed.
在美国，没有关于助产士对产科肛门括约肌损伤（OASIs）的知识和管理的数据。我们进行了一项横断面全国性调查，通过认证的护士助产士（CNMs）描述 OASI 的实践情况，假设只有少数助产士亲自修复 OASI，并且在 CNM OASI 培训/教育方面存在差距。
我们通过 REDCap 互联网向美国助产士学院（ACNM）的 6909 名成员发送了电子邮件调查。我们分析了每月至少进行一次分娩的活跃临床医生的回复，询问了 OASI 的风险、预防、修复和管理。我们总结了描述性数据，然后根据患者和提供者的特征评估了 OASI 知识。
我们收到了 1070 份（15.5%）完成的调查，其中 832 份（77.8%）符合纳入/排除标准。参与者与 ACNM 成员相似。受访者最常识别出先前的 OASI（87%）和营养（71%）是产前 OASI 的风险因素，而较少识别出初产妇（36%）和种族（22%）。确定的分娩期风险因素包括产钳分娩（94%）和中线会阴切开术（88%）。当怀疑有产科裂伤时，13.6%的受访者常规进行直肠检查。只有 15%的参与者亲自进行 OASI 修复。总体而言，参与者答对了 64%的基于证据的答案。30%的受访者参加了 OASI 教育/培训课程，44%的受访者知道其所在小组/机构的 OASI 方案。在评估的所有因素中，只有受访者的教育/CME 和方案因素对基于证据的回复比例有影响。
关于 OASI 预防和管理的质量倡议可能会改善护理。我们的数据表明，对助产士进行 OASI 培训可能会改善美国的分娩护理。需要对其他产科提供者进行进一步的研究。
