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Prevention and Management of Severe Obstetric Anal Sphincter Injuries (OASIs): a National Survey of Nurse- Midwives

  • Sindi Diko
  • Maryam Guiahi
  • Amy Nacht
  • Kathleen A. Connell
  • Shane Reeves
  • Beth A. Bailey
  • K. Joseph HurtEmail author
Original Article
  • 12 Downloads

Abstract

Introduction and hypothesis

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Cross-sectional Education Midwifery OASIs Perineal trauma Quality improvement 

Notes

Acknowledgements

We acknowledge Andre Owens for his assistance implementing the invitations and Nicole Carlson, CNM, PhD, for her input on project design and the consensus process. We especially thank all the participants from ACNM without whom we could not have done this work.

Funding

This work was supported by the Rocky Vista University College of Osteopathic Medicine Intramural Research Grant (SD), the Department of Obstetrics and Gynecology (KJH), the Society of Family Planning Junior Investigator Career Grant SFPRF10-JI1 (MG), and the NIH/NCRR Colorado CTSI grant no. UL1 RR025780 (RedCap resource). Its contents are the authors’ sole responsibility and do not necessarily represent official UC Denver, Rocky Vista University, or NIH views.

Compliance with ethical standards

Financial disclaimer/conflict of interest

None.

References

  1. 1.
    Friedman AM, Ananth CV, Prendergast E, D'Alton ME, Wright JD. Evaluation of third-degree and fourth-degree laceration rates as quality indicators. Obstet Gynecol. 2015;125(4):927–37.  https://doi.org/10.1097/AOG.0000000000000720.CrossRefGoogle Scholar
  2. 2.
    Lewicky-Gaupp C, Leader-Cramer A, Johnson LL, Kenton K, Gossett DR. Wound complications after obstetric anal sphincter injuries. Obstet Gynecol. 2015;125(5):1088–93.CrossRefGoogle Scholar
  3. 3.
    Marsh F, Lynne R, Christine L, Alison W. Obstetric anal sphincter injury in the UK and its effect on bowel, bladder and sexual function. Eur J Obstet Gynecol Reprod Biol. 2011;154(2):223–7.  https://doi.org/10.1016/j.ejogrb.2010.09.006.CrossRefGoogle Scholar
  4. 4.
    Fitzpatrick M, Fynes M, Cassidy M, Behan M, O'Connell PR, O'Herlihy C. Prospective study of the influence of parity and operative technique on the outcome of primary anal sphincter repair following obstetrical injury. Eur J Obstet Gynecol Reprod Biol. 2000;89(2):159–63.CrossRefGoogle Scholar
  5. 5.
    Williams A, Lavender T, Richmond DH, Tincello DG. Women's experiences after a third-degree obstetric anal sphincter tear: a qualitative study. Birth. 2005;32(2):129–36.  https://doi.org/10.1111/j.0730-7659.2005.00356.x.CrossRefGoogle Scholar
  6. 6.
    Mellgren A, Jensen LL, Zetterstrom JP, Wong WD, Hofmeister JH, Lowry AC. Long-term cost of fecal incontinence secondary to obstetric injuries. Dis Colon Rectum. 1999;42(7):857–65.CrossRefGoogle Scholar
  7. 7.
    Hamilton BE MJ, Osterman MJK, Curtin, SC, Mathews TJ (2015) Births: Final Data for 2014. National Center for Health Statistics. http://www.midwife.org/CNM/CM-attended-Birth-Statistics. Accessed Sept 4 2018.
  8. 8.
    Bick DE, Ismail KM, Macdonald S, Thomas P, Tohill S, Kettle C. How good are we at implementing evidence to support the management of birth related perineal trauma? A UK wide survey of midwifery practice. BMC Pregnancy and Childbirth. 2012;12:57.  https://doi.org/10.1186/1471-2393-12-57.CrossRefGoogle Scholar
  9. 9.
    Mutema EK. A tale of two cities: auditing midwifery practice and perineal trauma. Br J of Midwifery. 2007;15:511–3.CrossRefGoogle Scholar
  10. 10.
    Agency for Healthcare Research and Quality. Guide to Patient Safety Indicators. (2003) US Department of Health and Human Services http://www.qualityindicators.ahrq.gov/downloads/modules/psi/v31/psi_guide_v31.pdf. Accessed September 15 2018.
  11. 11.
    Agency for Healthcare Research and Quality. (2014) US Department of Health and Human Services https://nhqrnet.ahrq.gov/inhqrdr/data/submit. Accessed June 6 2018.
  12. 12.
  13. 13.
    Harris PA, RT RT, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) - a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.CrossRefGoogle Scholar
  14. 14.
    Practice Bulletin No. 165: Prevention and Management of Obstetric Lacerations at Vaginal Delivery. Obstet Gynecol. 2016;128(1):e1–e15.CrossRefGoogle Scholar
  15. 15.
    Nair R, Aggarwal R, Khanna D. Methods of formal consensus in classification/diagnostic criteria and guideline development. Semin Arthritis Rheum. 2011;41(2):95–105.  https://doi.org/10.1016/j.semarthrit.2010.12.001.CrossRefGoogle Scholar
  16. 16.
    Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery. Obstet Gynecol. 2018;132(3):e87–e102.  https://doi.org/10.1097/AOG.0000000000002841.CrossRefGoogle Scholar
  17. 17.
    ACNM Essential Facts About Midwives. American College of Nurse-Midwives http://www.midwife.org/Essential-Facts-about-Midwives. Accessed June 1 2018.
  18. 18.
    IIBM Corp. Released. BM SPSS statistics for windows, version 24.0. Armonk, NY: IBM Corp; 2016.Google Scholar
  19. 19.
    Davies-Tuck M, Biro MA, Mockler J, Stewart L, Wallace EM, East C. Maternal Asian ethnicity and the risk of anal sphincter injury. Acta Obstet Gynecol Scand. 2015;94(3):308–15.  https://doi.org/10.1111/aogs.12557.CrossRefGoogle Scholar
  20. 20.
    Ramage L, Yen C, Qiu S, Simillis C, Kontovounisios C, Tan E, et al. Does a missed obstetric anal sphincter injury at time of delivery affect short-term functional outcome? Ann R Coll Surg Engl. 2018;100(1):26–32.  https://doi.org/10.1308/rcsann.2017.0140.CrossRefGoogle Scholar
  21. 21.
    Andrews V, Sultan AH, Thakar R, Jones PW. Occult anal sphincter injuries—myth or reality? BJOB. 2006;113(2):195–200.  https://doi.org/10.1111/j.1471-0528.2006.00799.x.Google Scholar
  22. 22.
    Fernando RJ, Sultan AH, Kettle C, Thakar R. Methods of repair for obstetric anal sphincter injury. Cochrane Database Syst Rev. 2013;12:CD002866.  https://doi.org/10.1002/14651858.CD002866.pub3.Google Scholar
  23. 23.
    Core Competencies for Basic Midwifery Practice (2012) American College of Nurse-Midwives http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000050/Core Comptencies Dec 2012.pdf. Accessed Oct 29 2018.
  24. 24.
    Agency for Healthcare Research and Quality. PSI 18 and 19: Obstetric Trauma Rate – Vaginal Delivery With and Without Instrument. http://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/d4k-laceration-bestpractices.pdf. Accessed March 30 2016.
  25. 25.
    Basu M, Smith D. Long-term outcomes of the stop traumatic OASI morbidity project (STOMP). Int J Gynaecol Obstet. 2018.  https://doi.org/10.1002/ijgo.12565.
  26. 26.
    Walker C, Rodriguez T, Herranz A, Espinosa JA, Sanchez E, Espuna-Pons M. Alternative model of birth to reduce the risk of assisted vaginal delivery and perineal trauma. Int Urogynecol J. 2012;23(9):1249–56.  https://doi.org/10.1007/s00192-012-1675-5.CrossRefGoogle Scholar
  27. 27.
    Mascarello KC (2017) Maternal complications and cesarean section without indication: systematic review and meta-analysis. 51.  https://doi.org/10.11606/s1518-8787.2017051000389.
  28. 28.
    Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: systematic review and meta-analysis. PLoS Med. 2018;15(1):e1002494.  https://doi.org/10.1371/journal.pmed.1002494.CrossRefGoogle Scholar
  29. 29.
    Eysenbach G. Improving the quality of web surveys: the checklist for reporting results of internet E-surveys (CHERRIES). J Med Internet Res. 2004;6(3):e34.  https://doi.org/10.2196/jmir.6.3.e34.CrossRefGoogle Scholar
  30. 30.
    Burton SJ, Sudweeks RR, Merrill PF, Wood B (1991) How to Prepare Better Multiple-Choice Test Items: Guidelines for University Faculty. Brigham Young University Testing Services.Google Scholar
  31. 31.
    Pit SW, Vo T, Pyakurel S. The effectiveness of recruitment strategies on general practitioner's survey response rates - a systematic review. BMC Med Res Methodol. 2014;14:76.  https://doi.org/10.1186/1471-2288-14-76.CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  • Sindi Diko
    • 1
  • Maryam Guiahi
    • 2
  • Amy Nacht
    • 3
  • Kathleen A. Connell
    • 4
    • 5
  • Shane Reeves
    • 6
  • Beth A. Bailey
    • 6
  • K. Joseph Hurt
    • 5
    • 6
    • 7
    Email author
  1. 1.Department of SurgerySt. Joseph’s University Medical CenterPatersonUSA
  2. 2.Divisions of Family Planning, Department of Obstetrics & GynecologyUniversity of Colorado Anschutz Medical CampusAuroraUSA
  3. 3.Nurse Midwifery Program, College of NursingUniversity of Colorado Anschutz Medical CampusAuroraUSA
  4. 4.Division of Urogynecology, Department of Obstetrics & GynecologyUniversity of Colorado Anschutz Medical CampusAuroraUSA
  5. 5.Division of Reproductive Sciences, Department of Obstetrics & GynecologyUniversity of Colorado Anschutz Medical CampusAuroraUSA
  6. 6.Division of Maternal Fetal Medicine, Department of Obstetrics & GynecologyUniversity of Colorado Anschutz Medical CampusAuroraUSA
  7. 7.University of Colorado Anschutz Medical CampusAuroraUSA

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