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Are obstetric anal sphincter ruptures preventable?-- large and consistent rupture rate variations between the Nordic countries and between delivery units in Norway.

https://arctichealth.org/en/permalink/ahliterature120162
Source
Acta Obstet Gynecol Scand. 2013 Jan;92(1):94-100
Publication Type
Article
Date
Jan-2013
Author
Katariina Laine
Wenche Rotvold
Anne Cathrine Staff
Author Affiliation
Department of Obstetrics, Oslo University Hospital, Ullevål, Oslo, Norway. kattiksen@yahoo.no
Source
Acta Obstet Gynecol Scand. 2013 Jan;92(1):94-100
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Adult
Anal Canal - injuries
Chi-Square Distribution
Delivery, Obstetric - adverse effects - methods
Denmark - epidemiology
Episiotomy - statistics & numerical data
Female
Finland - epidemiology
Humans
Incidence
Norway - epidemiology
Obstetric Labor Complications - epidemiology
Parity
Pregnancy
Registries
Rupture
Sweden - epidemiology
Abstract
To study changes in the incidence of obstetric anal sphincter rupture (OASR) during recent years in Denmark, Finland, Sweden and Norway and hospital-based incidence in recent years in Norway.
Retrospective birth register study.
Unselected population of delivering women in four Nordic countries.
All deliveries (574 175) registered in Denmark, Finland, Norway and Sweden, 2004-2010.
Parity data, including maternal, obstetrical and fetal characteristics, were obtained. The incidence of OASR was calculated from vaginal deliveries. A chi-squared test was used to analyse differences between countries and time periods.
Incidence of OASR.
During the study period, the OASR incidence in Finland was notably lower (0.7-1.0%) than in the other three Nordic countries (4.2-2.3%). A significant and constant reduction in OASR incidence was observed in Norway only (from 4.1 to 2.3%, from 2004 to 2010, p
PubMed ID
23034015 View in PubMed
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Delivery parameters, neonatal parameters and incidence of urinary incontinence six months postpartum: a cohort study.

https://arctichealth.org/en/permalink/ahliterature285944
Source
Acta Obstet Gynecol Scand. 2017 Oct;96(10):1214-1222
Publication Type
Article
Date
Oct-2017
Author
Stian Langeland Wesnes
Yngvild Hannestad
Guri Rortveit
Source
Acta Obstet Gynecol Scand. 2017 Oct;96(10):1214-1222
Date
Oct-2017
Language
English
Publication Type
Article
Keywords
Birth weight
Cesarean Section - statistics & numerical data
Cohort Studies
Delivery, Obstetric - adverse effects - statistics & numerical data
Episiotomy - statistics & numerical data
Female
Humans
Incidence
Norway - epidemiology
Postpartum Period
Pregnancy
Puerperal Disorders - epidemiology
Regression Analysis
Risk factors
Urinary Incontinence - epidemiology
Abstract
Contradictory results have been reported regarding most delivery parameters as risk factors for urinary incontinence. We investigated the association between the incidence of urinary incontinence six months postpartum and single obstetric risk factors as well as combinations of risk factors.
This study was based on the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health during 1998-2008. This substudy was based on 7561 primiparous women who were continent before and during pregnancy. Data were obtained from questionnaires answered at weeks 15 and 30 of pregnancy and six months postpartum. Data were linked to the Medical Birth Registry of Norway. Single and combined delivery- and neonatal parameters were analyzed by logistic regression analyses.
Birthweight was associated with significantly higher risk of urinary incontinence six months postpartum [3541-4180 g: odds ratio (OR) 1.4, 95% confidence interval (CI) 1.2-1.6; >4180 g: OR 1.6, 95% CI 1.2-2.0]. Fetal presentation, obstetric anal sphincter injuries, episiotomy and epidural analgesia were not significantly associated with increased risk of urinary incontinence. The following combinations of risk factors among women delivering by spontaneous vaginal delivery increased the risk of urinary incontinence six months postpartum; birthweight =3540 g and =36 cm head circumference; birthweight =3540 g and forceps, birthweight =3540 g and episiotomy; and =36 cm head circumference and episiotomy.
Some combinations of delivery parameters and neonatal parameters seem to act together and may increase the risk of incidence of urinary incontinence six months postpartum in a synergetic way.
PubMed ID
28626856 View in PubMed
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Episiotomy counts: trends and prevalence in Canada, 1981/1982 to 1993/1994.

https://arctichealth.org/en/permalink/ahliterature207388
Source
Birth. 1997 Sep;24(3):141-7
Publication Type
Article
Date
Sep-1997
Author
I D Graham
D F Graham
Author Affiliation
Clinical Epidemiology Unit (C410), Ottawa Civic Hospital, Ontario, Canada.
Source
Birth. 1997 Sep;24(3):141-7
Date
Sep-1997
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Epidemiologic Studies
Episiotomy - statistics & numerical data - utilization
Female
Humans
Pregnancy
Prevalence
United States - epidemiology
Abstract
The purpose of this study was to produce a minimum estimate of the prevalence of episiotomy use in Canada, and to investigate the trend in its use between 1981/1982 and 1993/1994.
A retrospective population case series study was conducted using hospital discharge abstracts. Outcome measures were the count of episiotomies performed during a 12-month period and the episiotomy rate per 100 vaginal births.
For more than a decade, official statistics have significantly underreported episiotomy use by as much as 50 percent. In 1993/1994 at least 37.7 percent of women giving birth vaginally in Canada are known to have received an episiotomy. Between 1981/1982 and 1993/1994 its prevalence declined 29.1 percent, with the greatest decline occurring during the 1990s. This decline did not result from changes in parity in the population. The decrease in episiotomy use during this 13-year period is more than twice that found in the United States (a decline of only 13.6%).
The reporting of official statistics on obstetric procedures in Canada should be modified to include all known cases of episiotomy. The observed downward trend in the rate of this procedure is encouraging, and is in the direction of evidence-based recommendations advocating its restrictive use.
PubMed ID
9355272 View in PubMed
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High episiotomy rate protects from obstetric anal sphincter ruptures: a birth register-study on delivery intervention policies in Finland.

https://arctichealth.org/en/permalink/ahliterature135820
Source
Scand J Public Health. 2011 Jul;39(5):457-63
Publication Type
Article
Date
Jul-2011
Author
Sari Räisänen
Katri Vehviläinen-Julkunen
Mika Gissler
Seppo Heinonen
Author Affiliation
Department of Nursing Science, University of Eastern Finland, 70211 Kuopio, Finland. shraisan@student.uef.fi
Source
Scand J Public Health. 2011 Jul;39(5):457-63
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Adult
Anal Canal - injuries
Delivery, Obstetric - methods
Episiotomy - statistics & numerical data - utilization
Female
Finland
Humans
Obstetric Labor Complications - prevention & control
Parity
Physician's Practice Patterns
Pregnancy
Registries
Retrospective Studies
Rupture - prevention & control
Young Adult
Abstract
To assess the impact of hospital episiotomy policy on obstetric and anal sphincter rupture (OASR, n = 2448) rates and risks among singleton vaginal deliveries in Finland between 1997 and 2007.
An observational, retrospective, population-based register study. All 424,297 women in hospitals with more than 1000 deliveries annually, were divided into three groups based on the episiotomy rate quartiles for 11 years and separated on the basis of whether the women were primiparous or multiparous. The lowest and the highest quartiles were compared against the hospitals with intermediate episiotomy rates, comprising the two quartiles around the median. Stepwise logistic regression analysis was used to adjust significant risk factors.
The annual range of episiotomy varied from 11 to 94% in primiparous women, and from 1 to 46% in multiparous women. After adjustment the risk of OASR appears to be 39% lower (OR 0.61, 95% CI 0.52-0.90) in primiparous and 45% lower (OR 0.55, 95% CI 0.42-0.72) in multiparous women delivered in the highest quartile hospitals. At an individual level, episiotomy was a protective factor (OR 0.82, 95% CI 0.75-0.91) in primiparous women, but increased the risk by 2.36-fold in multiparous women (OR 2.36, 95% CI 1.86-2.84).
The results suggest that high episiotomy rate provided protection from OASR among both groups of women. Among the multiparous women, the 2.4-fold risk of OASR related to episiotomy at an individual level might be explained by confounding by indication, since episiotomy was performed more often to women at a high risk of OASR.
PubMed ID
21444353 View in PubMed
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Incidence and risk factors for obstetric anal sphincter ruptures, OASIS, following the introduction of preventive interventions. A retrospective cohort study from a Norwegian hospital 2012-2017.

https://arctichealth.org/en/permalink/ahliterature309137
Source
Sex Reprod Healthc. 2019 Dec; 22:100460
Publication Type
Journal Article
Date
Dec-2019
Author
Tone Selmer-Olsen
Ellen Aagaard Nohr
Christian Tappert
Torbjørn Moe Eggebø
Author Affiliation
Department of Obstetrics, Trondheim University Hospital (St. Olavs Hospital), Trondheim, Norway. Electronic address: tone.selmer-olsen@stolav.no.
Source
Sex Reprod Healthc. 2019 Dec; 22:100460
Date
Dec-2019
Language
English
Publication Type
Journal Article
Keywords
Adult
Anal Canal - injuries
Delivery, Obstetric - adverse effects - methods
Episiotomy - statistics & numerical data
Female
Humans
Incidence
Lacerations - epidemiology
Maternal Age
Norway - epidemiology
Obstetric Labor Complications - epidemiology - etiology - prevention & control
Parturition
Pregnancy
Retrospective Studies
Risk factors
Rupture - epidemiology - etiology - prevention & control
Abstract
A decrease of obstetric anal sphincter injuries (OASIS) was observed after preventive interventions were implemented at a Norwegian university hospital. The aim was to investigate whether the improvement had sustained over the following years.
We performed a retrospective cohort study of 18 258 singleton vaginal cephalic births, =37?+?0?weeks of gestation during 2012-2017, examining data from the hospital's birth journals and separate registration forms. Interventions to prevent OASIS were implemented in 2011, and training in practical skills was repeated each year.
The main outcome was OASIS (n?=?377).
Frequency of OASIS overall decreased from 3.6% prior to 2011 to 2.1% after the intervention and sustained at that level throughout the study period. A trend of fewer OASIS among spontaneous deliveries, decreasing from 2.1% to 1.2% (p?=?0.01) was observed, but no trend was seen for instrumental deliveries (p?=?0.37), where the incidence fluctuated between 4.0% and 9.3% with an average of 6.5%. Primiparity, increased maternal age and increased fetal head circumference were associated with more OASIS in spontaneous deliveries. In instrumental deliveries, primiparity, occiput posterior position and increased fetal head circumference were associated with more OASIS, whilst episiotomy was associated with fewer OASIS.
The incidence of obstetric anal sphincter injuries maintained at a similar level of around 2.1% during the six following years after introducing preventive interventions. Regularly repetition and practical training seemed to be effective.
PubMed ID
31491687 View in PubMed
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A population-based register study to determine indications for episiotomy in Finland.

https://arctichealth.org/en/permalink/ahliterature132880
Source
Int J Gynaecol Obstet. 2011 Oct;115(1):26-30
Publication Type
Article
Date
Oct-2011
Author
Sari Räisänen
Katri Vehviläinen-Julkunen
Mika Gisler
Seppo Heinonen
Author Affiliation
Savonia University of Applied Sciences, Iisalmi, Finland. sari.raisanen@savonia.fi
Source
Int J Gynaecol Obstet. 2011 Oct;115(1):26-30
Date
Oct-2011
Language
English
Publication Type
Article
Keywords
Adult
Anal Canal - injuries
Delivery, Obstetric - methods
Episiotomy - statistics & numerical data - trends
Female
Finland
Humans
Logistic Models
Obstetric Labor Complications - prevention & control
Parity
Pregnancy
Prevalence
Registries - statistics & numerical data
Retrospective Studies
Risk factors
Young Adult
Abstract
To evaluate whether there is a shift in the episiotomy target group from women at low risk to those at high risk of obstetric anal sphincter injuries, concomitant with a decrease in the use of episiotomy.
A population-based register of 514,741 women with singleton vaginal deliveries recorded in the Finnish Medical Birth Register was reviewed. Primiparous and multiparous women with episiotomy were compared to women without episiotomy for possible risk factors via stepwise logistic regression analysis. The prevalence and risk of episiotomy were evaluated over 5 time periods from 1997 to 2007.
The occurrence of episiotomy decreased from 71.5% in 1997-1999 to 54.9% in 2006-2007 among primiparous women, and from 21.5% in 1997-2001 to 9.2% in 2006-2007 among multiparous women. The use of episiotomy decreased in not only low-risk but also high-risk women who had operative vaginal or breech deliveries, macrosomic newborns, and oxytocin augmentation. The ratio of episiotomy use remained relatively unchanged in different subgroups even though episiotomy policy became increasingly restrictive over time.
The spectrum of episiotomy indications has not changed over time, and use of episiotomy has declined arbitrarily to a similar extent among high- and low-risk women.
PubMed ID
21767841 View in PubMed
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Randomised controlled trial of pelvic floor muscle training during pregnancy.

https://arctichealth.org/en/permalink/ahliterature179198
Source
BMJ. 2004 Aug 14;329(7462):378-80
Publication Type
Article
Date
Aug-14-2004
Author
Kjell A Salvesen
Siv Mørkved
Author Affiliation
Department of Obstetrics and Gynaecology, Trondheim University Hospital St. Olav, N-7006 Trondheim, Norway. pepes@medisin.ntnu.no
Source
BMJ. 2004 Aug 14;329(7462):378-80
Date
Aug-14-2004
Language
English
Publication Type
Article
Keywords
Episiotomy - statistics & numerical data
Exercise Therapy - methods
Female
Humans
Labor Stage, Second
Obstetric Labor Complications - prevention & control
Pelvic Floor
Pregnancy
Urinary Incontinence - prevention & control
Abstract
To examine a possible effect on labour of training the muscles of the pelvic floor during pregnancy.
Randomised controlled trial.
Trondheim University Hospital and three outpatient physiotherapy clinics in a primary care setting.
301 healthy nulliparous women randomly allocated to a training group (148) or a control group (153).
A structured training programme with exercises for the pelvic floor muscles between the 20th and 36th week of pregnancy.
Duration of the second stage of labour and number of deliveries lasting longer than 60 minutes of active pushing among women with spontaneous start of labour after 37 weeks of pregnancy with a singleton fetus in cephalic position.
Women randomised to pelvic floor muscle training had a lower rate of prolonged second stage labour (24%, 95% confidence interval 16% to 33%; 22 out of 105 women were at risk (undelivered) at 60 minutes in the survival analysis) than women allocated to no training (38% (37/109), 28% to 47%). The duration of the second stage was not significantly shorter (40 minutes v 45 minutes, P = 0. 06).
A structured training programme for the pelvic floor muscles is associated with fewer cases of active pushing in the second stage of labour lasting longer than 60 minutes.
Notes
Cites: BJOG. 2002 Jan;109(1):68-7611845813
Cites: Cochrane Database Syst Rev. 2000;(3):CD00005110908458
Cites: Acta Obstet Gynecol Scand. 1988;67(5):437-403218463
Cites: Obstet Gynecol. 2003 Feb;101(2):313-912576255
Comment In: Aust J Physiother. 2004;50(4):25815643712
PubMed ID
15253920 View in PubMed
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Striving for scientific stringency: a re-analysis of a randomised controlled trial considering first-time mothers' obstetric outcomes in relation to birth position.

https://arctichealth.org/en/permalink/ahliterature118735
Source
BMC Pregnancy Childbirth. 2012;12:135
Publication Type
Article
Date
2012
Author
Li Thies-Lagergren
Linda J Kvist
Kyllike Christensson
Ingegerd Hildingsson
Author Affiliation
Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Stockholm SE-171 76, Sweden.
Source
BMC Pregnancy Childbirth. 2012;12:135
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Analgesia, Epidural - statistics & numerical data
Delivery, Obstetric - methods
Episiotomy - statistics & numerical data
Female
Humans
Labor Stage, Second
Labor, Obstetric
Oxytocics - therapeutic use
Oxytocin - therapeutic use
Parity
Patient Positioning - methods
Perineum - injuries - physiopathology
Postpartum Hemorrhage - epidemiology
Pregnancy
Sweden - epidemiology
Time Factors
Young Adult
Abstract
The aim of this study was to compare maternal labour and birth outcomes between women who gave birth on a birth seat or in any other position for vaginal birth and further, to study the relationship between synthetic oxytocin augmentation and maternal blood loss, in a stratified sample.
A re-analysis of a randomized controlled trial in Sweden. An on-treatment analysis was used to study obstetrical outcomes for nulliparous women who gave birth on a birth seat (birth seat group) compared to birth in any other position for vaginal birth (control group). Data were collected between November 2006 and July 2009. The outcome measurements included perineal outcome, post partum blood loss, epidural analgesia, synthetic oxytocin augmentation and duration of labour.
The major findings of this paper were that women giving birth on the birth seat had shorter duration of labour and were significantly less likely to receive synthetic oxytocin for augmentation in the second stage of labour. Significantly more women had an increased blood loss when giving birth on the birth seat, but had no difference in perineal outcomes. Blood loss was increased regardless of birth position if women had been exposed to synthetic oxytocin augmentation during the first stage of labour.
The results of this analysis imply that women with a straightforward birth process may well benefit from giving birth on a birth seat without risk for any adverse obstetrical outcomes. However it is important to bear in mind that, women who received synthetic oxytocin during the first stage of labour may have an increased risk for greater blood loss when giving birth on a birth seat. Finally it is of vital importance to scrutinize the influence of synthetic oxytocin administered during the first stage of labour on blood loss postpartum, since excessive blood loss is a well-documented cause of maternal mortality worldwide and may cause severe maternal morbidity in high-income countries.
Unique Protocol ID: NCT01182038 ( http://register.clinicaltrials.gov).
Notes
Cites: Midwifery. 2004 Mar;20(1):27-3615020025
Cites: Wien Klin Wochenschr. 2003 Oct 31;115(19-20):720-314650948
Cites: Birth. 1991 Mar;18(1):5-102006963
Cites: Br J Obstet Gynaecol. 1997 May;104(5):567-719166199
Cites: CMAJ. 2006 Aug 15;175(4):34716908892
Cites: BJOG. 2007 Mar;114(3):349-5517217358
Cites: Women Birth. 2007 Jun;20(2):41-817467355
Cites: J Adv Nurs. 2008 Aug;63(4):347-5618727762
Cites: J Midwifery Womens Health. 2009 May-Jun;54(3):191-20019410211
Cites: BMC Pregnancy Childbirth. 2011;11:2221435238
Cites: Infect Control Hosp Epidemiol. 2012 Feb;33(2):207-8; author reply 208-1022227995
Cites: Semin Perinatol. 2012 Feb;36(1):19-2622280861
Cites: BMC Pregnancy Childbirth. 2011;11:9722123123
Cites: Clin Trials. 2012 Feb;9(1):48-5521948059
Cites: Cochrane Database Syst Rev. 2012;5:CD00200622592681
Cites: Midwifery. 2012 Aug;28(4):E456-6021820774
Cites: Midwifery. 2013 Apr;29(4):344-5023084490
Cites: Nurs Prax N Z. 2002 Mar;18(1):4-1612113144
Cites: Br J Obstet Gynaecol. 1989 Nov;96(11):1290-62692698
PubMed ID
23173988 View in PubMed
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Symptoms after obstetric sphincter injuries have little effect on quality of life.

https://arctichealth.org/en/permalink/ahliterature121381
Source
Acta Obstet Gynecol Scand. 2013 Jan;92(1):109-15
Publication Type
Article
Date
Jan-2013
Author
Anna Palm
Leif Israelsson
Marie Bolin
Ingela Danielsson
Author Affiliation
Department of Obstetrics and Gynecology, Sundsvall Hospital, Sundsvall, Sweden. anna.palm@lvn.se
Source
Acta Obstet Gynecol Scand. 2013 Jan;92(1):109-15
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Adult
Anal Canal - injuries
Delivery, Obstetric - adverse effects
Dyspareunia - epidemiology - psychology
Episiotomy - statistics & numerical data
Fecal Incontinence - epidemiology - psychology
Female
Humans
Obstetric Labor Complications - psychology
Pregnancy
Pregnancy outcome
Prevalence
Quality of Life
Questionnaires
Sweden - epidemiology
Abstract
To compare the prevalence of anal incontinence and dyspareunia in women with or without obstetric sphincter injury after standardizing the suture technique.
Retrospective case-control study.
Regional hospital, Sweden.
305 women with an obstetric sphincter injury and 297 women with spontaneous vaginal delivery.
In order to standardize and improve the repairing skills of sphincter injuries, collaboration between obstetricians and colorectal surgeons was begun in 2000. Inner and external sphincters were repaired in two layers with continuous monofilament polidioxane sutures. The participating women received a questionnaire with validated questions on anal incontinence, dyspareunia and quality of life. The follow-up time was 15 months to 8 years.
Anal incontinence, dyspareunia and quality of life.
Of the sphincter group, 72% returned the questionnaire, as did 67% in the control group. Significantly more women in the sphincter group suffered from incontinence of flatus and loose stool compared to controls (p
PubMed ID
22913404 View in PubMed
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Use of routine interventions in labour and birth in Canadian hospitals: comparing results of the 1993 and 2007 Canadian hospital maternity policies and practices surveys.

https://arctichealth.org/en/permalink/ahliterature128820
Source
J Obstet Gynaecol Can. 2011 Dec;33(12):1208-17
Publication Type
Article
Date
Dec-2011
Author
Cheryl Levitt
Louise Hanvey
Sharon Bartholomew
Janusz Kaczorowski
Beverley Chalmers
Maureen Heaman
Xiaoke Li
Author Affiliation
Department of Family Medicine, McMaster University, Hamilton ON.
Source
J Obstet Gynaecol Can. 2011 Dec;33(12):1208-17
Date
Dec-2011
Language
English
Publication Type
Article
Keywords
Anesthesia, Obstetrical - statistics & numerical data
Canada
Delivery, Obstetric - methods
Enema
Episiotomy - statistics & numerical data
Evidence-Based Practice
Female
Fetal Monitoring - statistics & numerical data
Health Care Surveys
Heart Rate, Fetal
Hospitals - standards
Humans
Labor, Obstetric
Maternal Health Services - methods - standards - trends
Policy
Practice Guidelines as Topic
Pregnancy
Time Factors
Abstract
To compare policies and practices of routine interventions in labour and birth in Canadian hospitals in 1993 and 2007 and to describe trends regarding adherence to evidence-based guidelines.
We used data from surveys of Canadian hospitals in 1993 and 2007 on routine maternity care practices and policies, including interventions in labour and birth.
The response rate of hospitals in 1993 was 91% (523/572), and in 2007 it was 92% (323/353). In 1993, 65% of hospitals (335/516) had a policy that all women should have initial electronic fetal heart rate monitoring, and in 2007, 74% (235/319) had such a policy. In 1993, 55% of hospitals (284/516) used epidural anaesthesia as one of the methods for pain control, and in 2007, 87% of hospitals (278/318) did so. In 1993, 37% of hospitals (193/521) had a "no enema/suppository" policy on admission, and in 2007, 88% (282/322) did. In 1993, 87% of hospitals (450/516) had a policy encouraging the presence of both the woman's partner and other labour support people in the room during the course of labour; in 2007, 80% (259/323) did. In 1993, hospitals estimated that 62% of primiparous women and 44% of multiparous women had an episiotomy in their units. In 2007, the episiotomy rate, irrespective of parity, was 17%. In 1993, 20% of hospitals (98/498) had a policy specifying the length of the second stage of labour, and in 2007, 33% (101/307) had such a policy.
Positive and negative trends in adherence to best practices were seen in policies and practices of routine interventions during labour and birth in Canadian hospitals between 1993 and 2007.
PubMed ID
22166274 View in PubMed
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10 records – page 1 of 1.