Incidence of Obstetric Anal Sphincter Injuries After a Protection Training

Study Overview
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Brief Summary
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This is a retrospective cohort study. This two cohort study seeks to compare the incidence of obstetric anal sphincter injuries (OASIS) in two time periods, before and after an educational workshop for improved perineal support.

Detailed Description
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Perineal trauma during vaginal delivery is a major health issue associated with significant morbidity. It has been associated with many long term sequelae, including urinary and fecal incontinence. Specifically, third and fourth degree lacerations are known risk factors for the development of fecal incontinence. Due to their serious impact, third or fourth degree perineal tears are a commonly tracked adverse event in obstetric care (Agency for Healthcare Research and Quality and Joint Commission). As such, incidence data will soon be available to third-party payers and to the public on the Internet. Moreover, functional impairment after perineal lacerations continues to be a significant impetus for legal claims. Thus, reducing OASIS while preserving maternal and fetal outcomes is an important goal in clinical obstetrics. At the two TriHealth tertiary care institutions, the overall rate of OASIS is 3.5%. This is comparable, but not superior, to published rates at other centers. In fact, the literature is quite variable, with reported incidences ranging from 0.25-6%. Indeed, TriHealth has recently set up a task force to reduce these injuries as part of recent endeavors for quality improvement. Prevention is the first step in improving these complications. This study seeks to decrease the incidence of obstetric and anal sphincter injuries that may occur during the birthing process by bringing in a notable physician to review techniques with the obstetrics residents to help avoid these injuries then observe the deliveries of the women enrolled.

Official Title
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Incidence of Obstetric Anal Sphincter Injuries After Training to Protect the Perineum

Conditions
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Obstetric Trauma

Intervention / Treatment
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* Procedure: Educational workshop


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Obstetrics resident patients 18 years and older women who delivered vaginally between Oct. 2014 and Dec.2016 Exclusion Criteria: Women who delivered by cesarean section, preterm deliveries (less than 32 weeks), and multiple gestations

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Before workshop<br>October 2014 to October 2015 Cohort which is the time frame before the educational workshop | |
| After workshop<br>December 2015 to December 2016 Cohort which is the time after the educational workshop | Procedure: Educational workshop<br>* The educational workshop for improved perineal support during vaginal delivery<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of obstetric anal sphincter injuries | This is identified by ICD-9 code of third or fourth degree lacerations. | before (between Oct. 2014 and Oct. 2015) and after (between Dec. 2015 and Dec. 2016_) an educational workshop (Nov. 2015) |