Can the incidence of obstetric anal sphincter injury be reduced? The STOMP experience

Abstract Objective To reduce the incidence of third and fourth degree perineal tears. Study design This was a quality improvement project followed by an audit of outcomes. The population consisted of all women delivering vaginally over a 12 month period following implementation of the quality improv...

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Bibliographic Details
Published in:European journal of obstetrics & gynecology and reproductive biology 2016-07, Vol.202, p.55-59
Main Authors: Basu, Maya, Smith, Dot, Edwards, Robin
Format: Article
Language:English
Subjects:
Adult
Anal Canal - injuries
Delivery, Obstetric - adverse effects
Female
Fourth degree tear
Humans
Incidence
Obstetric anal sphincter injury
Obstetric Labor Complications - epidemiology
Obstetric Labor Complications - prevention & control
Obstetrics and Gynecology
Perineum - injuries
Pregnancy
Prevention
Third degree tear
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Summary:Abstract Objective To reduce the incidence of third and fourth degree perineal tears. Study design This was a quality improvement project followed by an audit of outcomes. The population consisted of all women delivering vaginally over a 12 month period following implementation of the quality improvement measures. Following a review of clinical factors associated with all third and fourth degree tears over a 3 month period and a review of relevant evidence, a series of measures to try and reduce the incidence of such tears were introduced. These measures were collectively known as STOMP (Stop Traumatic OASIS Morbidity Project). These were adopted by all staff in our unit, with an accompanying programme of workshops and a publicity campaign to promote staff engagement. Data were collected on all third and fourth degree tears for a 12 month period following project launch. The primary outcome was the incidence of third and fourth degree perineal tears over a 12 month period. Results There were a total of 3902 vaginal births during the 12 month period following project launch. Following full STOMP implementation, there was a significant decrease in the incidence of third/fourth degree tears (4.7% vs 2.2%, p < 0.0001). The reduction was most pronounced in the first 5 months (4.7% vs 1.51%, p < 0.0001). Conclusions STOMP is a simple and low cost series of measures that has lead to a significant decrease in the incidence of third and fourth degree tears in this cohort of women.
ISSN:0301-2115
1872-7654
DOI:10.1016/j.ejogrb.2016.04.033