{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T14:03:24Z","timestamp":1792159404847,"version":"4.4.0"},"reference-count":39,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,8,9]],"date-time":"2020-08-09T00:00:00Z","timestamp":1596931200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the impact of a care bundle (antenatal information to women, manual perineal protection and mediolateral episiotomy when indicated) on obstetric anal sphincter injury (OASI) rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Multicentre stepped\u2010wedge cluster design.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Sixteen maternity units located in four regions across England, Scotland and Wales.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Women with singleton live births between October 2016 and March 2018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Stepwise region by region roll\u2010out every 3\u00a0months starting January 2017. The four maternity units in a region started at the same time. Multi\u2010level logistic regression was used to estimate the impact of the care bundle, adjusting for time trend and case\u2010mix factors (age, ethnicity, body mass index, parity, birthweight and mode of birth).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Obstetric anal sphincter injury in singleton live vaginal births.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 55\u00a0060 singleton live vaginal births were included (79% spontaneous and 21% operative). Median maternal age was 30\u00a0years (interquartile range 26\u201334\u00a0years) and 46% of women were primiparous. The OASI rate decreased from 3.3% before to 3.0% after care bundle implementation (adjusted odds ratio 0.80, 95% CI 0.65\u20130.98, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.03). There was no evidence that the effect of the care bundle differed according to parity (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.77) or mode of birth (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.31). There were no significant changes in caesarean section (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.19) or episiotomy rates (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.16) during the study period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The implementation of this care bundle reduced OASI rates without affecting caesarean section rates or episiotomy use. These findings demonstrate its potential for reducing perineal trauma during childbirth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>OASI Care Bundle reduced severe perineal tear rates without affecting caesarean section rates or episiotomy use.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.16396","type":"journal-article","created":{"date-parts":[[2020,8,9]],"date-time":"2020-08-09T14:30:44Z","timestamp":1596983444000},"page":"584-592","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":86,"title":["Impact of a quality improvement project to reduce the rate of obstetric anal sphincter injury: a multicentre study with a stepped\u2010wedge design"],"prefix":"10.1111","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6517-3485","authenticated-orcid":false,"given":"I","family":"Gurol\u2010Urganci","sequence":"first","affiliation":[{"name":"Department of Health Services Research and Policy London School of Hygiene &amp; Tropical Medicine London UK"},{"name":"RCOG Centre for Quality Improvement and Clinical Audit Royal College of Obstetricians and Gynaecologists London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8506-9880","authenticated-orcid":false,"given":"P","family":"Bidwell","sequence":"additional","affiliation":[{"name":"RCOG Centre for Quality Improvement and Clinical Audit Royal College of Obstetricians and Gynaecologists London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7560-8924","authenticated-orcid":false,"given":"N","family":"Sevdalis","sequence":"additional","affiliation":[{"name":"Health Service &amp; Population Research Department Centre for Implementation Science King\u2019s College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Silverton","sequence":"additional","affiliation":[{"name":"Royal College of Midwives London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V","family":"Novis","sequence":"additional","affiliation":[{"name":"RCOG Centre for Quality Improvement and Clinical Audit Royal College of Obstetricians and Gynaecologists London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Freeman","sequence":"additional","affiliation":[{"name":"University Hospitals Plymouth NHS Trust Plymouth UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Hellyer","sequence":"additional","affiliation":[{"name":"RCOG Centre for Quality Improvement and Clinical Audit Royal College of Obstetricians and Gynaecologists London UK"},{"name":"UCLPartners London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9451-2335","authenticated-orcid":false,"given":"J","family":"van der Meulen","sequence":"additional","affiliation":[{"name":"Department of Health Services Research and Policy London School of Hygiene &amp; Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5279-141X","authenticated-orcid":false,"given":"R","family":"Thakar","sequence":"additional","affiliation":[{"name":"Croydon Health Services NHS Trust Croydon UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,8,9]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1177\/135626229900500601","article-title":"Obstetric perineal injury and anal incontinence","volume":"5","author":"Sultan A","year":"1999","journal-title":"Clinical Risk"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jmwh.12283"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12363"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2015.06.025"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.4103\/0366-6999.164874"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(16)31018-0"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/birt.12346"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2009.04.033"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-011-1454-8"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12547"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2003.03030.x"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-015-2625-9"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2014.07.002"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2012-001649"},{"key":"e_1_2_6_16_1","first-page":"u217936.w7106","article-title":"Reducing the incidence of Obstetric Sphincter Injuries using a hands\u2010on technique: an interventional quality improvement project","volume":"5","author":"Rasmussen O","year":"2016","journal-title":"BMJ Quality"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31816c4402"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181eda77a"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12274"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/SPV.0000000000000506"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2018.09.021"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-018-1965-0"},{"key":"e_1_2_6_23_1","volume-title":"The management of third and fourth\u2010degree perineal tears. RCOG Green\u2010top Guideline No. 29","author":"Royal College of Obstetricians and Gynaecologists","year":"2015"},{"key":"e_1_2_6_24_1","unstructured":"OASI Care Bundle Project Team.OASI Care Bundle Project materials.2019[https:\/\/www.rcog.org.uk\/en\/guidelines\u2010research\u2010services\/audit\u2010quality\u2010improvement\/oasi\u2010care\u2010bundle\/materials\/]. Accessed 24 July 2020."},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-84628-503-5_2"},{"key":"e_1_2_6_26_1","volume-title":"Births in Scottish Hospitals. Year ending 31 March 2018","author":"Information Services Division Scotland","year":"2018"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2006.05.007"},{"key":"e_1_2_6_28_1","volume-title":"Patterns of maternity care in English NHS trusts 2013\/14","author":"Royal College of Obstetricians & Gynaecologists","year":"2016"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.2202\/1557-4679.1195"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-017-1833-7"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jphys.2017.11.008"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-015-0842-7"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjquality.u217936.w7106"},{"key":"e_1_2_6_34_1","first-page":"A5075","article-title":"Manual protection of the perineum reduces the risk of obstetric anal sphincter ruptures","volume":"62","author":"Leenskjold S","year":"2015","journal-title":"Dan Med J"},{"key":"e_1_2_6_35_1","first-page":"S1","article-title":"Reducing obstetric anal sphincter injuries using perineal support a preliminary experience","volume":"20","author":"Naidu M","year":"2014","journal-title":"Female Pelvic Med Reconstr Surg"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1675352"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2006.00799.x"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13431"},{"key":"e_1_2_6_39_1","first-page":"CD006672","article-title":"Perineal techniques during the second stage of labour for reducing perineal trauma","volume":"6","author":"Aasheim V","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.12565"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.16396","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1471-0528.16396","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.16396","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T06:17:56Z","timestamp":1693203476000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/1471-0528.16396"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,9]]},"references-count":39,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021,2]]}},"alternative-id":["10.1111\/1471-0528.16396"],"URL":"https:\/\/doi.org\/10.1111\/1471-0528.16396","archive":["Portico"],"relation":{},"ISSN":["1470-0328","1471-0528"],"issn-type":[{"value":"1470-0328","type":"print"},{"value":"1471-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,9]]},"assertion":[{"value":"2020-06-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-08-09","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}