{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T21:11:15Z","timestamp":1792444275258,"version":"4.5.0"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2024,9,27]],"date-time":"2024-09-27T00:00:00Z","timestamp":1727395200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,9,27]],"date-time":"2024-09-27T00:00:00Z","timestamp":1727395200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int Urogynecol J"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction and Hypothesis<\/jats:title>\n                <jats:p>The objective was to implement an evidence-based peri-partum care bundle for women sustaining obstetric anal sphincter injuries and to evaluate compliance with recommendations for antibiotics use, repair in the operating room, and follow-up before and after implementation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This project was reviewed by the Institutional Review Board and determined to be exempt. A clinical care bundle containing education and standardized orders in the electronic medical record was implemented. Characteristics of pre- (October 2017 to September 2019) and post-intervention (October 2019 to August 2021) cohorts were compared and compliance with recommendations for antibiotics use, surgical repair location, and follow-up were evaluated. Chi-squared, Fisher\u2019s exact, ANOVA F, and Kruskal\u2013Wallis tests were performed, as indicated. Significance level was <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 185 cases were identified. Seventy-five percent of women were nulliparous. Mean gestational age was 39\u00a0weeks. Pre- and post-intervention groups did not differ in age, BMI, race, parity, gestational age, comorbidities, birthweight, or delivery type. Ninety-eight cases were identified pre-implementation. Eighty-six (88%) had third-degree lacerations. Post-implementation, 87 cases were identified. Seventy (80%) had third-degree lacerations (<jats:italic>p<\/jats:italic>\u2009=\u20090.17). Recommended antibiotic-type use improved from 35% pre-implementation to 93% post-implementation (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Repair in the operating room was similar pre-implementation and post-implementation (16.0% vs 12.6%, <jats:italic>p<\/jats:italic>\u2009=\u20090.48). Post-partum follow-up within 2\u00a0weeks improved from 16.3% pre-implementation to 52.8% post-implementation and mean time to follow-up was shorter post-implementation than pre-implementation (18 vs 33\u00a0days; both <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Implementation of an evidence-based peri-partum care bundle resulted in standardization of care in accordance with established recommendations. Compliance with recommendations for surgical repair in the operating room remained unchanged.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00192-024-05885-2","type":"journal-article","created":{"date-parts":[[2024,9,27]],"date-time":"2024-09-27T13:02:59Z","timestamp":1727442179000},"page":"2125-2130","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Obstetric Anal Sphincter Injury Care Bundle: A Quality Improvement Initiative"],"prefix":"10.1007","volume":"35","author":[{"given":"T. Clark","family":"Powell","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya P.","family":"Hoke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle P.","family":"Norris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret R.","family":"Page","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Todd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David T.","family":"Redden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia G.","family":"Brumfield","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"J. Michael","family":"Straughn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly E.","family":"Richter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,9,27]]},"reference":[{"issue":"6","key":"5885_CR1","doi-asserted-by":"publisher","first-page":"849","DOI":"10.1007\/s00192-015-2893-4","volume":"27","author":"S Jha","year":"2016","unstructured":"Jha S, Parker V. Risk factors for recurrent obstetric anal sphincter injury (rOASI): a systematic review and meta-analysis. Int Urogynecol J. 2016;27(6):849\u201357.","journal-title":"Int Urogynecol J"},{"issue":"5","key":"5885_CR2","doi-asserted-by":"publisher","first-page":"425.e1","DOI":"10.1016\/j.ajog.2012.06.055","volume":"207","author":"EC Evers","year":"2012","unstructured":"Evers EC, et al. Obstetrical anal sphincter laceration and anal incontinence 5\u201310 years after childbirth. Am J Obstet Gynecol. 2012;207(5):425.e1\u20136.","journal-title":"Am J Obstet Gynecol"},{"issue":"6","key":"5885_CR3","doi-asserted-by":"publisher","first-page":"1543","DOI":"10.1016\/j.ajog.2003.09.030","volume":"189","author":"DE Fenner","year":"2003","unstructured":"Fenner DE, et al. Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol. 2003;189(6):1543\u20139; discussion 1549\u201350.","journal-title":"Am J Obstet Gynecol"},{"issue":"6","key":"5885_CR4","doi-asserted-by":"publisher","first-page":"486","DOI":"10.3109\/01443615.2014.911835","volume":"34","author":"C Evans","year":"2014","unstructured":"Evans C, et al. Management of obstetric anal sphincter injuries (OASIS) in subsequent pregnancy. J Obstet Gynaecol. 2014;34(6):486\u20138.","journal-title":"J Obstet Gynaecol"},{"issue":"4","key":"5885_CR5","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1097\/AOG.0000000000000720","volume":"125","author":"AM Friedman","year":"2015","unstructured":"Friedman AM, et al. Evaluation of third-degree and fourth-degree laceration rates as quality indicators. Obstet Gynecol. 2015;125(4):927\u201337.","journal-title":"Obstet Gynecol"},{"issue":"1","key":"5885_CR6","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.ijgo.2013.09.034","volume":"125","author":"V Pergialiotis","year":"2014","unstructured":"Pergialiotis V, et al. Risk factors for severe perineal lacerations during childbirth. Int J Gynaecol Obstet. 2014;125(1):6\u201314.","journal-title":"Int J Gynaecol Obstet"},{"issue":"11","key":"5885_CR7","doi-asserted-by":"publisher","first-page":"2247","DOI":"10.1007\/s00192-020-04464-5","volume":"31","author":"JC Roper","year":"2020","unstructured":"Roper JC, et al. Review of available national guidelines for obstetric anal sphincter injury. Int Urogynecol J. 2020;31(11):2247\u201359.","journal-title":"Int Urogynecol J"},{"issue":"5","key":"5885_CR8","doi-asserted-by":"publisher","first-page":"1088","DOI":"10.1097\/AOG.0000000000000833","volume":"125","author":"C Lewicky-Gaupp","year":"2015","unstructured":"Lewicky-Gaupp C, et al. Wound complications after obstetric anal sphincter injuries. Obstet Gynecol. 2015;125(5):1088\u201393.","journal-title":"Obstet Gynecol"},{"issue":"6","key":"5885_CR9","doi-asserted-by":"publisher","first-page":"1268","DOI":"10.1097\/AOG.0b013e31816de8ad","volume":"111","author":"N Duggal","year":"2008","unstructured":"Duggal N, et al. Antibiotic prophylaxis for prevention of postpartum perineal wound complications: a randomized controlled trial. Obstet Gynecol. 2008;111(6):1268\u201373.","journal-title":"Obstet Gynecol"},{"issue":"16","key":"5885_CR10","doi-asserted-by":"publisher","first-page":"4257","DOI":"10.1007\/s11606-022-07602-5","volume":"37","author":"S Hempel","year":"2022","unstructured":"Hempel S, et al. Evidence-based quality improvement: a scoping review of the literature. J Gen Intern Med. 2022;37(16):4257\u201367.","journal-title":"J Gen Intern Med"},{"key":"5885_CR11","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/s13012-015-0209-1","volume":"10","author":"BJ Powell","year":"2015","unstructured":"Powell BJ, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implement Sci. 2015;10:21.","journal-title":"Implement Sci"},{"key":"5885_CR12","volume-title":"IHI Innovation Series white paper","author":"R Resar","year":"2012","unstructured":"Resar R, Griffin FA, Haraden C, Nolan TW. Using care bundles to improve health care quality. In: IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2012."},{"issue":"7","key":"5885_CR13","doi-asserted-by":"publisher","first-page":"1989","DOI":"10.1007\/s00192-021-04786-y","volume":"32","author":"M Jurczuk","year":"2021","unstructured":"Jurczuk M, et al. The OASI care bundle quality improvement project: lessons learned and future direction. Int Urogynecol J. 2021;32(7):1989\u201395.","journal-title":"Int Urogynecol J"},{"issue":"3","key":"5885_CR14","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1097\/AOG.0000000000001908","volume":"129","author":"JD Illston","year":"2017","unstructured":"Illston JD, et al. Modified beef tongue model for fourth-degree laceration repair simulation. Obstet Gynecol. 2017;129(3):491\u20136.","journal-title":"Obstet Gynecol"},{"issue":"6","key":"5885_CR15","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1056\/NEJMoa1800566","volume":"379","author":"WA Grobman","year":"2018","unstructured":"Grobman WA, et al. Labor induction versus expectant management in low-risk nulliparous women. N Engl J Med. 2018;379(6):513\u201323.","journal-title":"N Engl J Med"},{"issue":"4","key":"5885_CR16","doi-asserted-by":"publisher","first-page":"327.e1","DOI":"10.1016\/j.ajog.2012.12.025","volume":"208","author":"L Stock","year":"2013","unstructured":"Stock L, et al. Factors associated with wound complications in women with obstetric anal sphincter injuries (OASIS). Am J Obstet Gynecol. 2013;208(4):327.e1\u20136.","journal-title":"Am J Obstet Gynecol"},{"issue":"1","key":"5885_CR17","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1097\/AOG.0000000000001523","volume":"128","author":"American College of Obstetricians and Gynecologists\u2019 Committee on Practice Bulletins\u2014Obstetrics","year":"2016","unstructured":"American College of Obstetricians and Gynecologists\u2019 Committee on Practice Bulletins\u2014Obstetrics. Practice bulletin no. 165: prevention and management of obstetric lacerations at vaginal delivery. Obstet Gynecol. 2016;128(1):e1\u201315.","journal-title":"Obstet Gynecol"},{"key":"5885_CR18","unstructured":"Royal College of Obstetricians and Gynaecologists. The management of third- and fourth-degree perineal tears. Green-top guideline no. 29. 2015. Accessed 6 Sept 2022. Available from: https:\/\/www.rcog.org.uk\/globalassets\/documents\/guidelines\/gtg-29.pdf."},{"issue":"1","key":"5885_CR19","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1002\/ijgo.13623","volume":"156","author":"CK Cox","year":"2022","unstructured":"Cox CK, et al. Antibiotic use during repair of obstetrical anal sphincter injury: a quality improvement initiative. Int J Gynaecol Obstet. 2022;156(1):95\u2013101.","journal-title":"Int J Gynaecol Obstet"}],"container-title":["International Urogynecology Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00192-024-05885-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00192-024-05885-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00192-024-05885-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,12]],"date-time":"2024-12-12T14:03:00Z","timestamp":1734012180000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00192-024-05885-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,27]]},"references-count":19,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2024,11]]}},"alternative-id":["5885"],"URL":"https:\/\/doi.org\/10.1007\/s00192-024-05885-2","relation":{},"ISSN":["0937-3462","1433-3023"],"issn-type":[{"value":"0937-3462","type":"print"},{"value":"1433-3023","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,27]]},"assertion":[{"value":"8 April 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 July 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 September 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors report no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of Interest"}}]}}