Reducing the frequency of episiotomies through a continuous quality improvement program

摘要: OBJECTIVE: To determine the effectiveness of a continuous quality improvement (CQI) program in reducing episiotomy rates. DESIGN: Before-and-after study; CQI methods were used to examine process care during labour and birth. INTERVENTIONS: Identification factors that would increase probability episiotomy. Implementation initiatives change minimize Educational strategies included promotion better understanding what constitutes an appropriate rate ways reduce maternal exhaustion true fetal distress as well manoeuvres protect perineum SETTING: Low-risk family practice obstetrics service tertiary hospital southwestern Ontario. PARTICIPANTS: All 102 physicians at study who provided intrapartum year before which was implemented women for whom (approximately 1,400 per year). OUTCOME MEASURES: Episiotomy rates (overall, among primiparous multiparous women, individual physicians) perineal tear, infection postpartum readmission. RESULTS: Although planned reduction not achieved period, overall decreased significantly from 44.5% 33.3% (p < 0.001). Among 57.6% 46.2% 0.001) 34.3% 23.6% The reduced associated with significant decrease third- fourth-degree tears number giving birth intact or minor (first-degree) tear. These benefits seen whose experiencing second-degree During intervention there no vaginal trauma bleeding, readmission because complications related trauma. most period. CONCLUSIONS: model may be useful modifying clinical practices such it focuses on environment is provided, both have major impact physician behaviour. Further needed ascertain sustainability effects this approach components had greatest effect.