Evaluation of Suzor forceps training by studying obstetric anal sphincter injuries: a retrospective study

Abstract Background Instrumental deliveries are an unavoidable part of obstetric practice. Dedicated training is needed for each instrument. To identify when a trainee resident can be entrusted with instrumental deliveries by Suzor forceps by studying obstetric anal sphincter injuries. Methods A French retrospective observational study of obstetric anal sphincter injuries due to Suzor forceps deliveries performed by trainee residents was conducted from November 2008 to November 2016 at Limoges University Hospital. Perineal lesion risk factors were studied. Sequential use of a vacuum extractor and then forceps was also analyzed. Results Twenty-one residents performed 1530 instrumental deliveries, which included 1164 (76.1%) using forceps and 89 (5.8%) with sequential use of a vacuum extractor and then forceps. Third and fourth degree perineal tears were diagnosed in 82 patients (6.5%). Residents caused fewer obstetric anal sphincter injuries after 23.82 (+/− 0.8) deliveries by forceps (p = 0.0041), or after 2.36 (+/− 0.7) semesters of obstetrical experience (p = 0.0007). No obese patient (body mass index> 30) presented obstetric anal sphincter injuries (p = 0.0013). There were significantly fewer obstetric anal sphincter injuries after performance of episiotomy (p < 0.0001), and more lesions in the case of the occipito-sacral position (p = 0.028). Analysis of sequential instrumentation did not find any additional associated risk. Conclusion Training in the use of Suzor forceps requires extended mentoring in order to reduce obstetric anal sphincter injuries. A stable level of competence was found after the execution of at least 24 forceps deliveries or after 3 semesters (18 months) of obstetrical experience.

Download Full-text

Risk Factors for Obstetric Anal Sphincter Injuries among Women Delivering at a Tertiary Hospital in Southwestern Uganda

Obstetrics and Gynecology International ◽

10.1155/2020/6035974 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Mahad Ali ◽

Richard Migisha ◽

Joseph Ngonzi ◽

Joy Muhumuza ◽

Ronald Mayanja ◽

...

Keyword(s):

Risk Factors ◽

Vaginal Delivery ◽

Anal Sphincter ◽

Tertiary Hospital ◽

Monthly Income ◽

Obstetric Anal Sphincter Injuries ◽

Perineal Tear ◽

Fourth Degree ◽

Anal Sphincter Injury ◽

Second Stage Of Labour

Background. Obstetric anal sphincter injuries (OASIS) arise from perineal trauma during vaginal delivery and are associated with poor maternal health outcomes. Most OASIS occur in unattended deliveries in resource-limited settings. However, even in facilities where deliveries are attended by skilled personnel, a number of women still get OASIS. Objectives. To determine the incidence and risk factors for obstetric anal sphincter injuries among women delivering at Mbarara Regional Referral Hospital (MRRH). Methods. We conducted an unmatched hospital-based case control study, with the ratio of cases to controls of 1 : 2 (80 cases and 160 controls). We defined a case as a mother who got a third- or fourth-degree perineal tear after vaginal delivery while the controls recruited were the next two mothers who delivered vaginally without a third- or fourth-degree perineal tear. A questionnaire and participants’ medical records review were used to obtain sociodemographic and clinical data. We estimated the incidence of OASIS and performed univariable and multivariable logistic regression to identify the associated risk factors. Results. The cumulative incidence for OASIS during the study period was 6.6%. The risk factors for OASIS were 2nd stage of labour ≥1 hour (aOR 6.07, 95%CI 1.86–19.82, p=0.003), having episiotomy performed during labour (aOR 2.57, 95%CI 1.07–6.17, p=0.035), perineum support during delivery (aOR 0.03, 95%CI 0.01–0.12, p<0.001), and monthly income of >50,000 shillings (aOR 0.09, 95%CI 0.03–0.28, p<0.001). Conclusions and Recommendations. The risk factors for obstetric anal sphincter injury were prolonged second stage of labour and performing episiotomies during deliveries while higher monthly income and perineum support during delivery were protective. We recommend routine support to the perineum during delivery. Care should be taken in mothers with episiotomies, as they can extend and cause OASIS.

Download Full-text

Diagnosis and Treatment of Obstetric Anal Sphincter Injuries: New Evidence and Perspectives

Journal of Clinical Medicine ◽

10.3390/jcm10153261 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3261

Author(s):

Antonino Spinelli ◽

Virginia Laurenti ◽

Francesco Maria Carrano ◽

Enrique Gonzalez-Díaz ◽

Katarzyna Borycka-Kiciak

Keyword(s):

Early Diagnosis ◽

Anal Sphincter ◽

Clinical Examination ◽

Therapeutic Strategy ◽

Clinical Presentation ◽

Late Onset ◽

Obstetric Anal Sphincter Injuries ◽

Fourth Degree ◽

Perineal Tears ◽

New Evidence

Perineal injury during childbirth is a common event with important morbidity associated in particular with third-and-fourth degree perineal tears (also referred to as obstetric anal sphincter injuries—OASIS). Early diagnosis of these damages is mandatory to define a prompt therapeutic strategy and thus avoid the development of late-onset consequences, such as faecal incontinence. For this purpose, various diagnostic exams can be performed after a thorough clinical examination. The management of OASIS includes several measures and should be individualized according to the timing and features of the clinical presentation.

Download Full-text

Risk factors for third- and fourth-degree perineal tears during vaginal delivery

Urogynaecologia ◽

10.4081/uij.2011.e2 ◽

2011 ◽

Vol 25 (1) ◽

pp. 2

Author(s):

Leonard Juul ◽

Gerhard B. Theron

Keyword(s):

Risk Factors ◽

Shoulder Dystocia ◽

Control Group ◽

Study Group ◽

Tertiary Referral Hospital ◽

Retrospective Case ◽

Fourth Degree ◽

Perineal Tears ◽

Vaginal Deliveries ◽

Hiv Negative

Objective. To identify risk factors for thirdand fourth-degree perineal tears, so as to anticipate and intervene in order to prevent this complication that can severely affect a woman’s quality of life. The study design was a retrospective case control study. Method. Ninety-three cases of third- and fourth-degree perineal tears were identified from the birth register of a tertiary referral hospital (Tygerberg Hospital). One hundred and nine patients with normal vaginal deliveries in the same time period were used as control group. Results. An analysis of the results revealed that there were no significant differences between cases and controls with regards to age, body mass index (BMI), gestation at delivery, duration of second stage, episiotomy and birth weight. However, there were significantly more primigravidas, assisted deliveries (forceps and vacuum), occipitoposterior positions, HIV negative patients and shoulder dystocia in the study group. Conclusions. Antenatal risk factors for thirdand fourth-degree tears are difficult to identify. However, intrapartum occipitoposterior and assisted deliveries, especially in the primigravid patient, should warn the obstetrician/ midwife about the risk of a severe tear. A restrictive episiotomy policy should be practiced. Shoulder dystocia was invariably associated with third- and fourth-degree tears in this study. The higher incidence of HIV negative patients in the study group requires further research.

Download Full-text

Incidence of hypoxemia in a post-anaesthesia care unit and relevant risk factors: a retrospective study of 14604 patients with general anaesthesia

10.21203/rs.2.12878/v1 ◽

2019 ◽

Author(s):

Shuai Tang ◽

Liangyan Zhang ◽

Wei Han ◽

Yang Xue ◽

Yi Tian ◽

...

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Regression Analysis ◽

Retrospective Study ◽

Retrospective Cohort ◽

Post Anaesthesia Care Unit ◽

Postoperative Hypoxemia ◽

Total Incidence ◽

American Society ◽

Anaesthesia Care

Abstract Background This article is aim to investigate the incidence and risk factors for postoperative hypoxemia in a post-anaesthesia care unit (PACU). Methods The retrospective cohort assessed 14604 postoperative patients who were admitted to PACU between January 2015 and December 2015. A pulse oximeter was used to monitor and record pulse oxygen saturation (SpO2) every 5 minutes. Clinical data were collected for all these patients, and the incidence of and risk factors for postoperative hypoxemia were analysed. Results The total incidence of hypoxemia was 21.83% (SpO2 ≤ 95%) and 2.79% (SpO2 ≤ 90%). Multiple regression analysis indicated that the risk factors were age ≥50-year old, body mass index (BMI) ≥25kg/m2, American Society of Anaesthesiologists (ASA) II and III, limb surgery, and thoracic surgery. Conclusions Therefore, hypoxemia was common in postoperative patients in the PACU. Age, BMI, ASA classification, and surgical site are associated with postoperative hypoxemia. More attention should be paid to these patients to prevent hypoxemia in the PACU.

Download Full-text

The Incidence, Risk Factors, Predictors, and Prognoses of Cytomegalovirus Reactivation in Immunocompetent Mechanical Ventilation Patients: A Prospective Observational Study

10.21203/rs.3.rs-247841/v1 ◽

2021 ◽

Author(s):

Zhihui Zhang ◽

Xuesong Liu ◽

Ling Sang ◽

Sibei Chen ◽

Zhan Wu ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Observational Study ◽

Prospective Observational Study ◽

Area Under The Curve ◽

University Hospital ◽

Laboratory Findings ◽

Cytomegalovirus Reactivation ◽

Cmv Reactivation ◽

Immunocompetent Patients

Abstract Background: Cytomegalovirus (CMV) reactivation can seriously affect the clinical prognoses of critically ill patients. However, the epidemiology and predictors of CMV in immunocompetent patients with mechanical ventilation are not very clear. Methods: A single-center, prospective observational study (conducted from June 30, 2017 to July 01, 2018) with a follow-up of 90 days (September 29, 2018) that included 71 CMV-seropositive immunocompetent patients with mechanical ventilation at a 37-bed university hospital general intensive care unit (ICU) in China. Routine detection of CMV DNAemia was performed once a week until 28 days (Day1, 7, 14, 21, 28) and serology, laboratory findings, and clinical data were obtained at admission.Results: Among 71 patients, 13 (18.3%) showed CMV reactivation within ICU 28-day admission. The median time to reactivation was 7 days. CMV reactivation was related to various factors, including body weight, body mass index (BMI), sepsis, NT-proBNP, BUN, and Hb levels (P< 0.05). In the multivariate regression model, BMI, Hb level, and sepsis were associated with CMV reactivation patients (P< 0.05). Moreover, the area under the curve (AUC) of BMI, Hb and BMI combined Hb was 0.69, 0.70, 0.76, respectively. The rate of complications, duration of mechanical ventilation, hospitalization expense, length of ICU stay, and 90-day all-cause mortality rate in patients with CMV reactivation was significantly higher than in those without CMV reactivation (P< 0.05).Conclusions: Among immunocompetent patients with mechanical ventilation, the incidence of CMV reactivation was high. CMV reactivation can lead to various adverse prognoses. BMI, Hb, and sepsis were independent risk factors for CMV reactivation. BMI and Hb may predict CMV reactivation.

Download Full-text

Obstetric Anal Sphincter Injuries – Maternal, Foetal and Sociodemographic Risk Factors: A Retrospective Register-Based Study

10.22541/au.163460613.32885708/v1 ◽

2021 ◽

Author(s):

Kristin André ◽

Andrea Stuart ◽

Kärin Kallén

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Caesarean Section ◽

Anal Sphincter ◽

Maternal Education ◽

Vacuum Extraction ◽

High Birth Weight ◽

Previous Caesarean Section ◽

Obstetric Anal Sphincter Injuries ◽

Increased Risk

Objective. To determine risk and protective factors of obstetric anal sphincter injuries (OASIS). Design. A retrospective register-based observational study. Setting. Sweden. Population. A cohort of 988, 988 singleton term deliveries 2005-2016 were included. Methods. Data from the Swedish Medical Birth Registry and Statistics Sweden were extracted to identify cases of OASIS and maternal and foetal characteristics. Modified Poisson Regression analyses were performed to assess risk factors. Main outcome measures. Risk ratios for OASIS with 95% confidence interval associated with maternal and foetal risk factors were calculated. Results. The rate of OASIS was 3.5% (n=34, 583). Primiparity (aRR 3.13 95% CI 3.05–3.21), vacuum extraction (aRR 2.79 95% CI 2.73–2.86), forceps (aRR 4.27 95% CI 3.86–4.72) and high birth weight (aRR 2.61 95% CI 2.50–2.72) were associated with a significantly increased risk of OASIS. Increasing maternal age and decreasing maternal height increased the risk of OASIS. Smoking (aRR 0.74 95% CI 0.70–0.79) and low maternal education (aRR 0.87 95% CI 0.83–0.92) were associated with a decreased frequency of reported OASIS. Obesity decreased the risk of OASIS (aRR 0.90 95% CI 0.87–0.94), but only after adjusting for foetal birth weight. Previous caesarean section increased the risk of OASIS (aRR 1.41; 95% CI 1.36–1.47). Conclusion. Primiparity, instrumental delivery and high birth weight increased the risk of OASIS. Risk factors including BMI, height, age, smoking, maternal education, ethnicity and previous caesarean section also contribute to the overall risk of OASIS. Keywords. Obstetric sphincter injuries, risk factors, pregnancy.

Download Full-text

A Simple, Reproducible and Low-cost Simulator for Teaching Surgical Techniques to Repair Obstetric Anal Sphincter Injuries

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0038-1668527 ◽

2018 ◽

Vol 40 (08) ◽

pp. 465-470 ◽

Cited By ~ 3

Author(s):

Roxana Knobel ◽

Lia Volpato ◽

Liliam Gervasi ◽

Raquel Viergutz ◽

Alberto Trapani

Keyword(s):

Anal Sphincter ◽

Low Cost ◽

Internal Sphincter ◽

Surgical Techniques ◽

External Sphincter ◽

Rectal Mucosa ◽

Obstetric Anal Sphincter Injuries ◽

Fourth Degree ◽

Anatomy And Physiology ◽

Application Techniques

Objective To describe and evaluate the use of a simple, low-cost, and reproducible simulator for teaching the repair of obstetric anal sphincter injuries (OASIS). Methods Twenty resident doctors in obstetrics and gynecology and four obstetricians participated in the simulation. A fourth-degree tear model was created using low-cost materials (condom simulating the rectal mucosa, cotton tissue simulating the internal anal sphincter, and bovine meat simulating the external anal sphincter). The simulator was initially assembled with the aid of anatomical photos to study the anatomy and meaning of each component of the model. The laceration was created and repaired, using end-to-end or overlapping application techniques. Results The model cost less than R$ 10.00 and was assembled without difficulty, which improved the knowledge of the participants of anatomy and physiology. The sutures of the layers (rectal mucosa, internal sphincter, and external sphincter) were performed in keeping with the surgical technique. All participants were satisfied with the simulation and felt it improved their knowledge and skills. Between 3 and 6 months after the training, 7 participants witnessed severe lacerations in their practice and reported that the simulation was useful for surgical correction. Conclusion The use of a simulator for repair training in OASIS is affordable (low-cost and easy to perform). The simulation seems to improve the knowledge and surgical skills necessary to repair severe lacerations. Further systematized studies should be performed for evaluation.

Download Full-text

Cardiac Risk Factors Among Saudi Stroke Patients: A Retrospective Study at a University Hospital.

International Journal of Medicine in Developing Countries ◽

10.24911/ijmdc.51-1634150802 ◽

2021 ◽

pp. 1

Author(s):

Abdullah Alamri ◽

Ibrahim Salloot ◽

Mohammed Alrasheed ◽

Fahad Albassam ◽

Musaad Alrashid

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Cardiac Risk ◽

University Hospital ◽

Stroke Patients ◽

Cardiac Risk Factors

Download Full-text

Abdominal Wall Hernias in End-Stage Renal Disease Patients on Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686080802800414 ◽

2008 ◽

Vol 28 (4) ◽

pp. 391-396 ◽

Cited By ~ 23

Author(s):

Gustavo Martínez-Mier ◽

Eduardo Garcia-Almazan ◽

Hugo E. Reyes-Devesa ◽

Victor Garcia-Garcia ◽

Sergio Cano-Gutierrez ◽

...

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Peritoneal Dialysis ◽

Body Mass ◽

Small Body ◽

Retrospective Chart Review ◽

University Hospital ◽

Dialysis Patients ◽

Dialysis Unit ◽

Mesh Hernioplasty

Objective To describe our experience with hernioplasty in peritoneal dialysis patients and to identify possible risk factors for surgical complications. Design A 4-year retrospective chart review of data. Setting Peritoneal dialysis unit of a university hospital. Patients and Methods 58 hernias in 50 patients were included. Detailed surgical technique and complications were recorded. Possible risk factors included age, gender, weight, height, body mass index, previous surgery, diabetes, time on dialysis, emergency surgery, hospital stay, type of hernia, mesh use, blood hemoglobin, and serum urea, creatinine, and potassium. Results Complications occurred in 12 hernioplasties (4 wound infections, 2 peritonitis, 4 catheter dysfunction, and 5 re-operations). Recurrence rate was 12% without mesh use and 0% with mesh hernioplasty. Dialysis was re-instituted in 96% of cases within 3 days postoperatively. Identified risk factors for complications were diabetes, low weight, low height, small body mass index, and low serum creatinine. Conclusions Mesh hernioplasty in peritoneal dialysis patients is advisable. Postoperative dialysis with low volume is feasible after surgery. Prospective studies will corroborate our risk factors for morbidity.

Download Full-text