The Perineal Tears Project: a quality assurance and practice improvement project to reduce obstetric anal sphincter injuries

Background: Obstetric anal sphincter injuries (OASI) were occurring at a higher rate than expected compared with Health Round Table National data (2011) in the maternity unit of a tertiary hospital in Queensland. These injuries cause significant morbidity and distress to women and their families and also impact on the resources and finances of health service providers. Aim: To investigate and establish the factors that influenced the high rate of OASI at the hospital, and to employ strategies that could reduce the number of women sustaining an OASI during childbirth. Methods: A retrospective audit of obstetric data between 2010 and 2012, to identify any influential factors was initially conducted along with a review of current resources to support clinical practice. These resources were updated, and education provided to implement evidence-based clinical guidelines to influence improvement in perineal care and reduce the rate of OASI. Results: Statistically significant reduction in OASI in all vaginal births was shown in 2012 data compared with 2010 data (4.6% vs 6.3%, p=0.007) without increasing the episiotomy rate. In primiparas, OASI during vaginal births decreased from 11% to 7.2% (p=0.001), however the episiotomy rate increased significantly in this group (p=0.014), and also for women having an instrumental delivery (p=0.005). There was a significant reduction in women experiencing an episiotomy and OASI during instrumental births, 17.61% vs 8.48% (p<0.001). For the primiparas group this was reduced from 15.52% to 5.97% (p