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首页> 外文期刊>Midirs midwifery digest >The Perineal Tears Project: a quality assurance and practice improvement project to reduce obstetric anal sphincter injuries
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The Perineal Tears Project: a quality assurance and practice improvement project to reduce obstetric anal sphincter injuries

机译：会阴泪项目：一项质量保证和实践改进项目，以减少产科肛门括约肌损伤

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Backgroynd: Obstetric anal sphincter injuries (OASI) were occurring at a higher rate than expected compared with Health Round Table National data (2011) in the maternity unit of a tertiary hospital in Queensland. These injuries cause significant morbidity and distress to women and their families and also impact on the resources and finances of health service providers.Aim: To investigate and establish the factors that influenced the high rate of OASI at the hospital, and to employ strategies that could reduce the number of women sustaining an OASI during childbirth.Methods: A retrospective audit of obstetric data between 2010 and 2012, to identify any influential factors was initially conducted along with a review of current resources to support clinical practice.These resources were updated, and education provided to implement evidence-based clinical guidelines to influence improvement in perineal care and reduce the rate of OASI.Resylts: Statistically significant reduction in OASI in all vaginal births was shown in 2012 data compared with 2010 data (4.6% vs 6.3%, p=0.007) without increasing the episiotomy rate. In primiparas, OASI during vaginal births decreased from 11% to 7.2% (p=0.001), however the episiotomy rate increased significantly in this group (p=0.014), and also for women having an instrumental delivery (p=0.005). There was a significant reduction in women experiencing an episiotomy and OASI during instrumental births, 17.61% vs8A8% (p<0.001). For the primiparas group this was reduced from 15.52% to 5.97% (p<0.001). Conclusions A number of strategies were employed simultaneously therefore it is difficult to determine which had the most effect on reducing the incidence of OASI. Improved education and training of clinicians in perineal care, delivery techniques and episiotomy are likely to have had an impact. Increased episiotomy rates amongst women considered to be at highest risk of OASI resulted in a significant reduction in third and fourth degree tears in these groups.
机译：背景：昆士兰州一家三级医院产科的产妇肛门括约肌损伤（OASI）发生率高于预期的“国家健康圆桌会议”国家数据（2011）。这些伤害给妇女及其家庭造成严重的发病率和痛苦，并影响卫生服务提供者的资源和财务。目的：调查并确定影响医院OASI高发生率的因素，并采取可能的策略方法：2010年至2012年间对产科数据进行回顾性审核，以发现任何影响因素，同时对当前资源进行回顾以支持临床实践，并更新了这些资源，并减少了分娩期间维持OASI的妇女人数。教育：实施循证医学指导以影响会阴部护理的改善并降低OASI发生率。研究方法：2012年的数据较2010年的数据显示所有阴道分娩的OASI的统计显着降低（4.6％vs 6.3％，p = 0.007），而不会增加会阴切开术的比率。在初产妇中，阴道分娩时的OASI从11％下降到7.2％（p = 0.001），但是在该组中，外阴切开术的比率显着增加（p = 0.014），并且对于有工具分娩的妇女（p = 0.005）。在工具性分娩期间经历会阴切开术和OASI的妇女显着减少，分别为17.61％和8A8％（p <0.001）。对于初产妇组，这一比例从15.52％降低至5.97％（p <0.001）。结论同时采用了多种策略，因此很难确定哪种方法对降低OASI的发生率影响最大。改善会阴部护理，分娩技术和会阴切开术的临床医生的教育和培训可能会产生影响。被认为是OASI风险最高的妇女中，外阴切开术率的增加导致这些组中三级和四级眼泪的明显减少。

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