Temporal trends in obstetric anal sphincter injury from the first vaginal delivery in Austria, Canada, Norway, and Sweden.
Adult
Anal Canal
/ injuries
Austria
/ epidemiology
Canada
/ epidemiology
Delivery, Obstetric
/ methods
Episiotomy
/ adverse effects
Female
Humans
Incidence
Lacerations
/ epidemiology
Norway
/ epidemiology
Obstetric Labor Complications
/ epidemiology
Pregnancy
Prospective Studies
Registries
Risk Factors
Sweden
/ epidemiology
Time Factors
birth register
forceps
obstetric anal sphincter injury
primipara
vacuum delivery
vaginal birth after cesarean section
Journal
Acta obstetricia et gynecologica Scandinavica
ISSN: 1600-0412
Titre abrégé: Acta Obstet Gynecol Scand
Pays: United States
ID NLM: 0370343
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
revised:
06
08
2021
received:
06
03
2021
accepted:
08
08
2021
pubmed:
27
8
2021
medline:
30
11
2021
entrez:
26
8
2021
Statut:
ppublish
Résumé
Obstetric anal sphincter injuries (OASI) are severe complications that can cause considerable short- and long-term morbidity. Austria, Canada, Norway, and Sweden have similar socio-economic characteristics, and all four countries have access to national birth registers. In this study, we hypothesized that the incidence of OASI should be very similar for different obstetric scenarios in these four countries. Therefore, the aim was to compare the incidence of OASI in these four countries in primiparous women, with spontaneous or instrumental delivery (vacuum or forceps), and in women with a first vaginal birth after cesarean section (VBAC). Aggregated data on 1 933 930 vaginally delivered primiparous women and women with VBAC were retrieved from the birth registers gathered in Austria, Canada, Norway, and Sweden. The annual rate of OASI (ICD-10 codes O70.2-O70.3) was presented as the percentage of women with a spontaneous delivery, vacuum or forceps delivery, and a VBAC during the period 2004-2016. The incidence of OASI varied considerably between countries and over time. Canada and Sweden had the highest rates, and Austria and Norway the lowest. In Norway, the rate of OASI decreased consistently for all types of deliveries after introducing a perineal protection program in 2004 (p < 0.001). During vacuum delivery, the incidence of OASI varied between countries from 4.1% to 15.5% across the study period. In Canada and Norway, the rate of OASI after a forceps delivery was similar in 2004 at ~20% and with differing trajectories to 24.3% (β 0.49) and 6.2% (β -1.15) (trend, all p < 0.001) in 2016. This comparative register study suggests that there may be considerable potential for lowering the incidence of OASI. The perineal protection program implemented by Norway has been successful. Each country should critically, without prejudice, analyze their current clinical practices and rate of OASI and consider the best preventive strategy.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1969-1976Subventions
Organisme : Gothenburg Continence Research Centre
Organisme : National grants LUA/ALF Sweden
ID : 11315
Organisme : Göteborgs Läkaresällskap
Organisme : Hjalmar Svensson Fund
Organisme : Healthcare Committee, Region Västra Götaland
Informations de copyright
© 2021 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).
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