The impact of variations in obstetric practice on maternal birth trauma

Ixora Kamisan @ Atan, Shek Ka Lai, Suzanne Langer, Jessica Caudwell-Hall, Hans Peter Dietz

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction and hypothesis: Forceps delivery and length of second stage are risk factors of maternal birth trauma, i.e., levator ani muscle (LAM) avulsion and anal sphincter trauma. The cesarean section (CS) rate has recently become the key performance indicator because of its increase worldwide. Attempts to reduce CS rates seem to have led to an increase in forceps deliveries and longer second stages. This study aimed to determine the association between variations in obstetric practice (between hospitals) and maternal birth trauma. Methods: This was a retrospective ancillary analysis involving 660 nulliparous women carrying an uncomplicated singleton term pregnancy in a prospective perinatal intervention trial at two Australian tertiary obstetric units. They had been seen antenatally and at 3–6 months postpartum for a standardized clinical assessment between 2007 and 2014. Primary outcome measures were sonographically diagnosed LAM and external anal sphincter (EAS) trauma. Results: The incidence of LAM avulsion (11.5% vs. 21.3%, P = 0.01) and composite trauma, i.e., LAM avulsion ± EAS injury (29.2% vs. 39.7%, P = 0.03) were higher in one of the two hospitals, where the forceps delivery rate was also higher (10.9% vs. 2.6%, P < 0.001). BMI (OR 0.9, P = 0.02), length of second stage (OR 1.01, P = 0.02) and forceps delivery (OR 5.24, P < 0.001) were significant predictors of the difference in LAM avulsion incidence between the hospitals. Maternal age (OR 1.06, P < 0.04) and forceps delivery (OR 8.66, P < 0.001) were significant predictors for composite trauma. Conclusions: A higher incidence of LAM avulsion and composite trauma in one of the two hospitals was largely explained by a higher forceps delivery rate.

Original languageEnglish
JournalInternational Urogynecology Journal
DOIs
Publication statusPublished - 1 Jan 2019

Fingerprint

Anal Canal
Obstetrics
Mothers
Parturition
Surgical Instruments
Wounds and Injuries
Muscles
Cesarean Section
Incidence
Maternal Age
Postpartum Period
Outcome Assessment (Health Care)
Pregnancy

Keywords

  • Anal sphincter trauma
  • Forceps delivery
  • Levator avulsion
  • Levator trauma
  • Maternal birth trauma
  • OASIS

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Urology

Cite this

The impact of variations in obstetric practice on maternal birth trauma. / Kamisan @ Atan, Ixora; Lai, Shek Ka; Langer, Suzanne; Caudwell-Hall, Jessica; Dietz, Hans Peter.

In: International Urogynecology Journal, 01.01.2019.

Research output: Contribution to journalArticle

Kamisan @ Atan, Ixora ; Lai, Shek Ka ; Langer, Suzanne ; Caudwell-Hall, Jessica ; Dietz, Hans Peter. / The impact of variations in obstetric practice on maternal birth trauma. In: International Urogynecology Journal. 2019.
@article{1183c3bdbfe94fe79ac6a2e1976cfa89,
title = "The impact of variations in obstetric practice on maternal birth trauma",
abstract = "Introduction and hypothesis: Forceps delivery and length of second stage are risk factors of maternal birth trauma, i.e., levator ani muscle (LAM) avulsion and anal sphincter trauma. The cesarean section (CS) rate has recently become the key performance indicator because of its increase worldwide. Attempts to reduce CS rates seem to have led to an increase in forceps deliveries and longer second stages. This study aimed to determine the association between variations in obstetric practice (between hospitals) and maternal birth trauma. Methods: This was a retrospective ancillary analysis involving 660 nulliparous women carrying an uncomplicated singleton term pregnancy in a prospective perinatal intervention trial at two Australian tertiary obstetric units. They had been seen antenatally and at 3–6 months postpartum for a standardized clinical assessment between 2007 and 2014. Primary outcome measures were sonographically diagnosed LAM and external anal sphincter (EAS) trauma. Results: The incidence of LAM avulsion (11.5{\%} vs. 21.3{\%}, P = 0.01) and composite trauma, i.e., LAM avulsion ± EAS injury (29.2{\%} vs. 39.7{\%}, P = 0.03) were higher in one of the two hospitals, where the forceps delivery rate was also higher (10.9{\%} vs. 2.6{\%}, P < 0.001). BMI (OR 0.9, P = 0.02), length of second stage (OR 1.01, P = 0.02) and forceps delivery (OR 5.24, P < 0.001) were significant predictors of the difference in LAM avulsion incidence between the hospitals. Maternal age (OR 1.06, P < 0.04) and forceps delivery (OR 8.66, P < 0.001) were significant predictors for composite trauma. Conclusions: A higher incidence of LAM avulsion and composite trauma in one of the two hospitals was largely explained by a higher forceps delivery rate.",
keywords = "Anal sphincter trauma, Forceps delivery, Levator avulsion, Levator trauma, Maternal birth trauma, OASIS",
author = "{Kamisan @ Atan}, Ixora and Lai, {Shek Ka} and Suzanne Langer and Jessica Caudwell-Hall and Dietz, {Hans Peter}",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s00192-019-03887-z",
language = "English",
journal = "International Urogynecology Journal and Pelvic Floor Dysfunction",
issn = "0937-3462",
publisher = "Springer London",

}

TY - JOUR

T1 - The impact of variations in obstetric practice on maternal birth trauma

AU - Kamisan @ Atan, Ixora

AU - Lai, Shek Ka

AU - Langer, Suzanne

AU - Caudwell-Hall, Jessica

AU - Dietz, Hans Peter

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction and hypothesis: Forceps delivery and length of second stage are risk factors of maternal birth trauma, i.e., levator ani muscle (LAM) avulsion and anal sphincter trauma. The cesarean section (CS) rate has recently become the key performance indicator because of its increase worldwide. Attempts to reduce CS rates seem to have led to an increase in forceps deliveries and longer second stages. This study aimed to determine the association between variations in obstetric practice (between hospitals) and maternal birth trauma. Methods: This was a retrospective ancillary analysis involving 660 nulliparous women carrying an uncomplicated singleton term pregnancy in a prospective perinatal intervention trial at two Australian tertiary obstetric units. They had been seen antenatally and at 3–6 months postpartum for a standardized clinical assessment between 2007 and 2014. Primary outcome measures were sonographically diagnosed LAM and external anal sphincter (EAS) trauma. Results: The incidence of LAM avulsion (11.5% vs. 21.3%, P = 0.01) and composite trauma, i.e., LAM avulsion ± EAS injury (29.2% vs. 39.7%, P = 0.03) were higher in one of the two hospitals, where the forceps delivery rate was also higher (10.9% vs. 2.6%, P < 0.001). BMI (OR 0.9, P = 0.02), length of second stage (OR 1.01, P = 0.02) and forceps delivery (OR 5.24, P < 0.001) were significant predictors of the difference in LAM avulsion incidence between the hospitals. Maternal age (OR 1.06, P < 0.04) and forceps delivery (OR 8.66, P < 0.001) were significant predictors for composite trauma. Conclusions: A higher incidence of LAM avulsion and composite trauma in one of the two hospitals was largely explained by a higher forceps delivery rate.

AB - Introduction and hypothesis: Forceps delivery and length of second stage are risk factors of maternal birth trauma, i.e., levator ani muscle (LAM) avulsion and anal sphincter trauma. The cesarean section (CS) rate has recently become the key performance indicator because of its increase worldwide. Attempts to reduce CS rates seem to have led to an increase in forceps deliveries and longer second stages. This study aimed to determine the association between variations in obstetric practice (between hospitals) and maternal birth trauma. Methods: This was a retrospective ancillary analysis involving 660 nulliparous women carrying an uncomplicated singleton term pregnancy in a prospective perinatal intervention trial at two Australian tertiary obstetric units. They had been seen antenatally and at 3–6 months postpartum for a standardized clinical assessment between 2007 and 2014. Primary outcome measures were sonographically diagnosed LAM and external anal sphincter (EAS) trauma. Results: The incidence of LAM avulsion (11.5% vs. 21.3%, P = 0.01) and composite trauma, i.e., LAM avulsion ± EAS injury (29.2% vs. 39.7%, P = 0.03) were higher in one of the two hospitals, where the forceps delivery rate was also higher (10.9% vs. 2.6%, P < 0.001). BMI (OR 0.9, P = 0.02), length of second stage (OR 1.01, P = 0.02) and forceps delivery (OR 5.24, P < 0.001) were significant predictors of the difference in LAM avulsion incidence between the hospitals. Maternal age (OR 1.06, P < 0.04) and forceps delivery (OR 8.66, P < 0.001) were significant predictors for composite trauma. Conclusions: A higher incidence of LAM avulsion and composite trauma in one of the two hospitals was largely explained by a higher forceps delivery rate.

KW - Anal sphincter trauma

KW - Forceps delivery

KW - Levator avulsion

KW - Levator trauma

KW - Maternal birth trauma

KW - OASIS

UR - http://www.scopus.com/inward/record.url?scp=85061385030&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061385030&partnerID=8YFLogxK

U2 - 10.1007/s00192-019-03887-z

DO - 10.1007/s00192-019-03887-z

M3 - Article

JO - International Urogynecology Journal and Pelvic Floor Dysfunction

JF - International Urogynecology Journal and Pelvic Floor Dysfunction

SN - 0937-3462

ER -