The effects of a severe perineal trauma prevention program in an Australian tertiary hospital: An observational study

Background: Severe perineal trauma during childbirth is associated with significant morbidity and rates internationally, are on the rise. Aims: To determine the impact of a prevention program on severe perineal trauma in a nulliparous population at a tertiary hospital in Australia. Methods: Routinely collected maternity data were used comparing outcomes in two time periods; two years before and two years after the introduction of the program. Categorical data were compared using the Chi Squared statistic and continuous data Student's t-test. Logistic regression examined the association between independent and dependent variables using unadjusted and adjusted odds ratios, with 95% confidence intervals and p-values with significance set at 0.05. The main outcome of interest is severe perineal trauma. Results: The proportion of women in this nulliparous population experiencing severe perineal trauma during vaginal birth decreased from 8.8% in the first time period to 5.6% in the second. Reductions were achieved in all modes of vaginal birth but were most pronounced in vacuum births. Rates of episiotomy increased between time periods and further analysis found that this was protective of severe perineal trauma in all modes of birth for women of Asian country of birth and only in forceps birth for non-Asian women. Factors found to contribute to severe perineal trauma in this population were Asian country of birth, neonatal weight >= 4000 gm, forceps birth and maternal age. Conclusions: The prevention program is associated with reduced rates of severe perineal trauma. The challenge for the service is to maintain this positive change. Crown Copyright (C) 2019 Published by Elsevier Ltd on behalf of Australian College of Midwives. All rights reserved.