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Created on : 20 Aug 2017
Modified on : 20 Aug 2017

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Bibliographical entry (without author) :

Does midwife experience affect the rate of severe perineal tears? - Birth - Vol. 44, 2 - ISBN: 1523-536X - p.161-166

Author(s) :

Mizrachi, Yossi; Leytes, Sophia; Levy, Michal; Hiaev, Zvia; Ginath, Shimon; Bar, Jacob; Kovo, Michal

Year of publication :

2017

URL(s) :

http://onlinelibrary.wiley.com/doi/10.1111/birt.12…
https://doi.org/10.1111/birt.12278

Résumé (français)  :

Abstract (English)  :

Background
Our aim was to study whether midwife experience affects the rate of severe perineal tears (3rd and 4th degree).
Methods
A retrospective cohort study of all women with term vertex singleton pregnancies, who underwent normal vaginal deliveries, in a single tertiary hospital, between 2011 and 2015, was performed. Exclusion criteria were instrumental deliveries and stillbirth. All midwives used a “hands on” technique for protecting the perineum. The midwife experience at each delivery was calculated as the time interval between her first delivery and current delivery. A comparison was performed between deliveries in which midwife experience was less than 2 years (inexperienced), between 2 and 10 years (moderately experienced), and more than 10 years (highly experienced). A multivariate regression analysis was performed to assess the association between midwife experience and the incidence of severe perineal tears, after controlling for confounders.
Results
Overall, 15 146 deliveries were included. Severe perineal tears were diagnosed in 51 (0.33%) deliveries. Women delivered by inexperienced midwives had a higher rate of severe perineal tears compared with women delivered by highly experienced midwives (0.5% vs 0.2%, respectively, P=.024). On multivariate regression analysis, midwife experience was independently associated with a lower rate of severe perineal tears, after controlling for confounding factors. Each additional year of experience was associated with a 4.7% decrease in the risk of severe perineal tears (adjusted OR 0.95 [95% CI 0.91–0.99, P=.03).
Conclusion
More experienced midwives had a lower rate of severe perineal tears, and may be preferred for managing deliveries of women at high risk for such tears.

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Argument (français) :

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Keywords :

➡ perineal/vaginal tears ; episiotomy

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Import 20/08/2017 — 20 Aug 2017