title: Multidisciplinary training in perineal care during labor and delivery for the reduction of anal sphincter injuries.
abstract: OBJECTIVE
  To determine whether the introduction of a multidisciplinary intrapartum perineal-care training program reduced the rate of obstetric anal sphincter injuries in patients undergoing vaginal deliveries.
  
  
  METHODS
  A prospective observational cohort study enrolled women undergoing vaginal deliveries at a district general hospital maternity unit in the United Kingdom between April 1, 2012 and March 31, 2014. All women experiencing obstetric anal sphincter injuries during the study period were identified and the rate of obstetric anal sphincter injuries before (2012-2013) a multidisciplinary training program was implemented was compared with the rate after (2013-2014) implementation using logistic regression analysis.
  
  
  RESULTS
  The study enrolled 4920 patients. Following the implementation of the training program, the rate of obstetric anal sphincter injuries decreased from 4.8% to 3.1% of vaginal deliveries (odds ratio 0.66; 95% confidence interval 0.493-0.899; P = 0.008).
  
  
  CONCLUSIONS
  The integration of intrapartum perineal-care training into mandatory annual staff training was associated with a statistically and clinically significant reduction in the rate of obstetric anal sphincter injuries.
authors.affiliation: Women and Children's Division, Musgrove Park Hospital, Taunton, Somerset, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Frost
authors.affiliation: Women and Children's Division, Musgrove Park Hospital, Taunton, Somerset, United Kingdom. Electronic address: rowan.gundry@nhs.net.
authors.forename: Rowan
authors.initials: R
authors.lastname: Gundry
authors.affiliation: Women and Children's Division, Musgrove Park Hospital, Taunton, Somerset, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Young
authors.affiliation: Women and Children's Division, Musgrove Park Hospital, Taunton, Somerset, United Kingdom.
authors.forename: Adel
authors.initials: A
authors.lastname: Naguib
mesh_terms: D001003:Anal Canal / Q000293:injuries*; D036861:Delivery, Obstetric / Q000193:education*; D004493:Education / Q000592:standards*; D004841:Episiotomy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D016017:Odds Ratio; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D006113:United Kingdom
keywords: Anal sphincter injury; Episiotomy; Intrapartum; Perineum; Training