Getting evidence into obstetric and midwifery practice: reducing perineal trauma.
OBJECTIVE
Frequent obstetric perineal morbidity in a hospital setting with service providers inexperienced in getting evidence into practice.


METHODS
Clinical practice improvement methodology in a tertiary referral obstetric unit.


METHODS
To cease active instruction to push in the second stage of labour; encourage the adoption of the left lateral position when delivering on a bed; use of the vacuum extractor rather than forceps where instrumental delivery indicated.


RESULTS
Improved perineal outcomes with a 21.5% increase in intact perineum rate and a 100% reduction in fourth degree perineal tears.


CONCLUSIONS
Clinical practice improvement methodology is a useful tool for getting evidence into practice, resulting in improved clinical outcomes.
Nicholl
Michael C
MC
Division Women's Children's and Family Health, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia. mnicholl@nsccahs.health.nsw.gov.au
Cattell
Miriam A
MA
D036861:Delivery, Obstetric; D019317:Evidence-Based Medicine; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008880:Midwifery; D009517:New South Wales; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D014947:Wounds and Injuries / Q000517:prevention & control*