ABSTRACT
Objective
This study evaluates whether maternity care providers document guideline-based recommendations
for the prevention and care of obstetrical anal sphincter injuries (OASIS) for their
labour and delivery patients.
Methods
We performed a cross-sectional study, aiming for a convenience sample of 60 primiparous
women, over 19 years of age, equally representative of patients who experienced severe
(third- and fourth-degree) and minimal (intact or first-degree) tears during vaginal
birth. Information on patient demographics, delivery details, and guideline-endorsed
preventative and management measures were collected. Descriptive statistics were used
when appropriate.
Results
We enrolled a total of 73 women, 34 of whom had severe tears and 39 of whom had minimal
tears. Preventative measures, including fetal head control and perineal support during
delivery, were documented for 1 out of 73 patients. The use of perineal massage and
warm compress to the perineum was not documented. A rectal exam after delivery was
documented for 30% (22/73) of all patients and 62% (21/34) of patients with OASIS.
Sixty-five percent (22/34) of patients with OASIS received intravenous antibiotics,
88% (30/34) received laxatives, and 100% received nonsteroidal anti-inflammatory drugs.
Post-void residual was not documented for any patients. Patients recalled being informed
about their OASIS in 68% (23/34) of cases and being referred to pelvic physiotherapy
in 47% (16/34) of cases.
Conclusion
In our study, perineal care practices during and after childbirth, as detailed in
the national OASIS guideline, were incompletely documented. This may indicate partial
guideline adherence or suboptimal medical record-keeping.
RÉSUMÉ
Objectif
Cette étude évalue si les fournisseurs de soins de maternité consignent les mesures
fondées sur les directives cliniques relativement à la prévention et à la prise en
charge des lésions obstétricales du sphincter anal (LOSA) chez leurs patientes parturientes.
Méthodologie
Nous avons réalisé une étude transversale en visant à obtenir un échantillon de convenance
de 60 femmes primipares âgées de 19 ans ou plus, échantillon aussi représentatif des
patientes ayant eu une déchirure sévère (troisième ou quatrième degré) et minimale
(intacte ou premier degré) pendant l'accouchement vaginal. Les données sur les caractéristiques
démographiques des patientes, les détails de l'accouchement et les mesures de prévention
et de prise en charge fondées sur les directives ont été colligées. Les statistiques
descriptives ont été utilisées au besoin.
Résultats
Nous avons inclus un total de 73 femmes, dont 34 ayant une déchirure sévère et 39
ayant une déchirure minimale. Les mesures préventives, notamment le contrôle de la
tête fœtale et le soutien périnéal pendant l'accouchement, ont été consignées chez
1 des 73 patientes. L'utilisation du massage périnéal ou d'une compresse chaude au
périnée n'a pas été consignée. L'examen rectal après l'accouchement a été consigné
pour 30 % (22 sur 73) des patientes et 62 % (21 sur 34) des patientes atteintes d'une
LOSA. Des patientes atteintes d'une LOSA, 65 % (22 sur 34) ont reçu des antibiotiques
intraveineux; 88 % (30 sur 34), des laxatifs; et 100 %, des anti-inflammatoires non
stéroïdiens. Le volume du résidu post-mictionnel n'a été documenté pour aucune des
patientes. Les patientes se rappelaient avoir été informées de leur LOSA dans 68 %
des cas (23 sur 34) et avoir été invitées à consulter en rééducation périnéale et
pelvienne dans 47 % des cas (16 sur 34).
Conclusion
Dans notre étude, les pratiques de soins périnéaux pendant et après l'accouchement,
comme détaillées dans la directive nationale sur les LOSA, n'ont pas été consignées
au complet. Ce constat pourrait indiquer une adhésion partielle aux directives ou
une tenue sous-optimale des dossiers médicaux.
Keywords
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Article info
Publication history
Published online: March 05, 2021
Footnotes
Disclosures: The authors decare they have nothing to disclose.
All authors have indicated they meet the journal's requirements for authorship.
Identification
Copyright
© 2021 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
