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Episiotomy and tear audit

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Natalie Smith

on 8 February 2014

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Transcript of Episiotomy and tear audit

Data was collected from BOS database from 2001-2013 and imported into Excel

Mode of delivery
Parity – primips vs multips
Use of forceps or vacuum
Perineal status

Crunching the numbers

8026 Vaginal births
1685 Caesarean births
Warragul has a low episiotomy rate, and a higher incidence of OASI compared to state data

A retrospective audit of all deliveries from 2001-2013 could help explain why..

What we want to know
In what circumstances have third degree tears occurred?

Spontaneous vs instrumental
Primips vs multips
With or without episiotomies?

Does having an episiotomy effect the OASI rate?

Selective vs routine episiotomy

Better awareness, recognition and diagnosis of OASI

Are rising rates in tears attributed to better diagnosis, or is there also a true rise in tears?

Episiotomy and OASI audit
Warragul Hospital

Natalie Smith
Monash Medical Student

Primips and OASI
OASI rate 5.4%
Spontaneous birth OASI rate 3.4%
Assisted birth OASI rate 8.3%

Forceps birth OASI rate 11.8%
Vacuum birth OASI rate 5.9%
Multips and OASI
OASI rate 1.4%
Spontaneous birth OASI rate 0.8%
Assisted birth rate 8.3%

Forceps birth OASI rate 6.9%
Vacuum birth OASI rate 5.2%
Making sense of the data - Trends in tears and episiotomies
In primips, does having an episiotomy have an effect on the OASI rate?
In multips does having an episiotomy have an effect on the OASI rate?
Preliminary findings
So what's next?
Episiotomy rates are increasing at Warragul Hospital

episiotomy is trending downwards over the last 12 years for primips, and
for multips

Slight increase in the trend of OASI

OASI rates have remained stable for primips and multips

No episiotomies have extended to OASIs in the last 5 years
74 multiparous women had an OASI in the last 12 years

49 % of these women had a previous Caesarean section
How many were VBAC?

43% had babies >4000g

Prospective audit

Indication for episiotomies in spontaneous and assisted births
e.g. Shoulder dystocia

Accoucher head control
Full transcript