Palestinian Perineum and Birth Complication Study

NCT02427854 | Completed

• 1 other identifier: 2014/1727
• Study Type: interventional
• Target: 51,041
• Locations: 1 country
• Sites: 4

Brief Summary

In this study the investigators want to assess complications associated to pregnancy and delivery, and interventions used during labor. Pregnancy and delivery related complications are a major health problem globally. Events during labor such as excessive bleeding, uterine rupture, emergency cesarean delivery; other instrumental deliveries and anesthesia problems are situations that potentially may lead to severe outcomes for the mother and child. Diabetes, anemia and hypertensive disorders may also complicate both the pregnancy and delivery. Between 60-80% of women delivering their first baby need suturing due to perineal tears (tears located to the area between the vagina and anus). Superficial perineal tears rarely cause long-term problems, but often lead to pain and discomfort immediately after birth. Deeper or severe perineal tears, involving the anal sphincter, may influence the woman's quality of life. This is mainly due to long-lasting pain, discomfort and sexual dysfunction, and the fact that obstetric anal sphincter tear is the main cause of anal incontinence. Recent clinical intervention studies have shown that the incidence of severe obstetric perineal tears may be reduced by 50-70% by introducing a bimanual support technique of the perineum. In these studies all midwives and gynecologists were trained in the bimanual support technique. When it comes to training in new medical techniques in general, some studies have shown that use of animated instructions on mobile phones may be a good alternative to the more traditional "hands-on" or "bedside" teaching methods. In a global perspective, it is important to study the efficacy of mobile units for transferring of new knowledge, especially for use in resource constrained settings.

Conditions

Complication of Labor and Delivery

Keywords

Major delivery complications; Perineal injuries; episiotomy

Outcome Measures

Primary Outcomes (1)

• Incidence of obstetric perineal injuries

  All degrees of perineal injuries, including episiotomies, before and after intervention (education of the labour room staff)

  24 months

Secondary Outcomes (2)

• Occurrence of major delivery complications

  24 months

• Occurrence of perineal injuries after education of the staff on diagnostics and repair

  24 months

Other Outcomes (5)

• Number of Participants with Adverse fetal outcome as a Measure of Safety and Tolerability

  24 months

• Number of participants with chronic diseases among delivering women in Palestine

  24 months

• Duration of delivery laboring women as a Measure of Safety and Tolerability

  24 months

Study Arms (3)

No training

NO INTERVENTION

Incidence of obstetric perineal injuries in the participating hospitals before implementation of the manual perineal protection method.

Education by animated training video

ACTIVE COMPARATOR

Incidence of obstetric perineal injuries in the participating hospitals, after the delivery unit staff has been educated and trained to a perineal support by an animated training video only.

Behavioral: Education by animated training video

Interactive hands on bedside training

ACTIVE COMPARATOR

Incidence of obstetric perineal injuries in the participating hospitals, after the delivery unit staff has been educated and trained to a perineal support by an animated training video and additionally by an interactive hands-on bedside training.

Procedure: Interactive hands-on bedside training

Interventions

Education by animated training video BEHAVIORAL

Training performed by watching an animated educational video.

Education by animated training video

Interactive hands-on bedside training PROCEDURE

Training performed as a traditional bedside training supported by a trainer in person.

Interactive hands on bedside training

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• all midwives and physicians working on labor ward in the participating hospitals.
• all women giving birth in the participating hospitals.
• both genders are included in the staff, and among the newborns

Sponsors & Collaborators

• Oslo University Hospital: lead
• Croydon University Hospital: collaborator
• University of Oslo: collaborator
• Birzeit University Palestine: collaborator
• University of Birmingham: collaborator

Study Sites (4)

Palestinian Medical Complex

Ramallah, West Bank, Palestinian Territories

Location

AL Aqsa

Gaza, Palestinian Territories

Location

Shift

Gaza, Palestinian Territories

Location

Hebron

Hebron, Palestinian Territories

Location

Related Publications (24)

• Laine K, Pirhonen T, Rolland R, Pirhonen J. Decreasing the incidence of anal sphincter tears during delivery. Obstet Gynecol. 2008 May;111(5):1053-7. doi: 10.1097/AOG.0b013e31816c4402.

  PMID: 18448735 BACKGROUND

• Laine K, Gissler M, Pirhonen J. Changing incidence of anal sphincter tears in four Nordic countries through the last decades. Eur J Obstet Gynecol Reprod Biol. 2009 Sep;146(1):71-5. doi: 10.1016/j.ejogrb.2009.04.033. Epub 2009 May 30.

  PMID: 19482405 BACKGROUND

• Laine K, Skjeldestad FE, Sandvik L, Staff AC. Incidence of obstetric anal sphincter injuries after training to protect the perineum: cohort study. BMJ Open. 2012 Oct 17;2(5):e001649. doi: 10.1136/bmjopen-2012-001649. Print 2012.

  PMID: 23075573 BACKGROUND

• Hals E, Oian P, Pirhonen T, Gissler M, Hjelle S, Nilsen EB, Severinsen AM, Solsletten C, Hartgill T, Pirhonen J. A multicenter interventional program to reduce the incidence of anal sphincter tears. Obstet Gynecol. 2010 Oct;116(4):901-908. doi: 10.1097/AOG.0b013e3181eda77a.

  PMID: 20859154 BACKGROUND

• Raisanen S, Cartwright R, Gissler M, Kramer MR, Laine K, Jouhki MR, Heinonen S. Changing associations of episiotomy and anal sphincter injury across risk strata: results of a population-based register study in Finland 2004-2011. BMJ Open. 2013 Aug 17;3(8):e003216. doi: 10.1136/bmjopen-2013-003216.

  PMID: 23955189 BACKGROUND

• Raisanen SH, Vehvilainen-Julkunen K, Gissler M, Heinonen S. Lateral episiotomy protects primiparous but not multiparous women from obstetric anal sphincter rupture. Acta Obstet Gynecol Scand. 2009;88(12):1365-72. doi: 10.3109/00016340903295626.

  PMID: 19852569 BACKGROUND

• Laine K, Rotvold W, Staff AC. Are obstetric anal sphincter ruptures preventable?-- large and consistent rupture rate variations between the Nordic countries and between delivery units in Norway. Acta Obstet Gynecol Scand. 2013 Jan;92(1):94-100. doi: 10.1111/aogs.12024. Epub 2012 Dec 5.

  PMID: 23034015 BACKGROUND

• Stedenfeldt M, Oian P, Gissler M, Blix E, Pirhonen J. Risk factors for obstetric anal sphincter injury after a successful multicentre interventional programme. BJOG. 2014 Jan;121(1):83-91. doi: 10.1111/1471-0528.12274. Epub 2013 May 20.

  PMID: 23682573 BACKGROUND

• Raisanen S, Vehvilainen-Julkunen K, Gissler M, Heinonen S. Up to seven-fold inter-hospital differences in obstetric anal sphincter injury rates- A birth register-based study in Finland. BMC Res Notes. 2010 Dec 23;3:345. doi: 10.1186/1756-0500-3-345.

  PMID: 21182773 BACKGROUND

• Raisanen S, Kancherla V, Kramer MR, Gissler M, Heinonen S. Placenta previa and the risk of delivering a small-for-gestational-age newborn. Obstet Gynecol. 2014 Aug;124(2 Pt 1):285-291. doi: 10.1097/AOG.0000000000000368.

  PMID: 25004348 BACKGROUND

• Raisanen S, Kancherla V, Gissler M, Kramer MR, Heinonen S. Adverse perinatal outcomes associated with moderate or severe maternal anaemia based on parity in Finland during 2006-10. Paediatr Perinat Epidemiol. 2014 Sep;28(5):372-80. doi: 10.1111/ppe.12134. Epub 2014 Jun 17.

  PMID: 24938307 BACKGROUND

• Al-Zirqi I, Stray-Pedersen B, Forsen L, Vangen S. Uterine rupture after previous caesarean section. BJOG. 2010 Jun;117(7):809-20. doi: 10.1111/j.1471-0528.2010.02533.x. Epub 2010 Mar 24.

  PMID: 20236103 BACKGROUND

• Zimmo MW, Laine K, Hassan S, Bottcher B, Fosse E, Ali-Masri H, Zimmo K, Falk RS, Lieng M, Vikanes A. Exploring the impact of indication on variation in rates of intrapartum caesarean section in six Palestinian hospitals: a prospective cohort study. BMC Pregnancy Childbirth. 2022 Dec 2;22(1):892. doi: 10.1186/s12884-022-05196-8.

  PMID: 36461037 BACKGROUND

• Hassan S, Laine K, Fosse E, Abu-Rmeileh NM, Ali-Masri HY, Zimmo M, Zimmo K, Vikanes A, Ismail KM. Induction Of Labor Among Singleton Pregnancies In Six Palestinian Governmental Hospitals: A Population-Based Cohort Study. Int J Womens Health. 2019 Nov 7;11:597-605. doi: 10.2147/IJWH.S215781. eCollection 2019.

  PMID: 31807087 BACKGROUND

• Ali-Masri HY, Hassan SJ, Zimmo KM, Zimmo MW, Ismail KMK, Fosse E, Alsalman H, Vikanes A, Laine K. Evaluation of Accuracy of Episiotomy Incision in a Governmental Maternity Unit in Palestine: An Observational Study. Obstet Gynecol Int. 2018 Oct 29;2018:6345497. doi: 10.1155/2018/6345497. eCollection 2018.

  PMID: 30510580 BACKGROUND

• Ali-Masri H, Hassan S, Fosse E, Zimmo KM, Zimmo M, Ismail KMK, Vikanes A, Laine K. Impact of electronic and blended learning programs for manual perineal support on incidence of obstetric anal sphincter injuries: a prospective interventional study. BMC Med Educ. 2018 Nov 12;18(1):258. doi: 10.1186/s12909-018-1363-3.

  PMID: 30419884 BACKGROUND

• Zimmo MW, Laine K, Hassan S, Bottcher B, Fosse E, Ali-Masri H, Zimmo K, Sorum Falk R, Lieng M, Vikanes A. Caesarean section in Palestine using the Robson Ten Group Classification System: a population-based birth cohort study. BMJ Open. 2018 Oct 24;8(10):e022875. doi: 10.1136/bmjopen-2018-022875.

  PMID: 30361403 BACKGROUND

• Zimmo K, Laine K, Fosse E, Zimmo M, Ali-Masri H, Zucknick M, Vikanes A, Hassan S. Episiotomy practice in six Palestinian hospitals: a population-based cohort study among singleton vaginal births. BMJ Open. 2018 Jul 16;8(7):e021629. doi: 10.1136/bmjopen-2018-021629.

  PMID: 30012790 BACKGROUND

• Zimmo KM, Laine K, Fosse E, Zimmo M, Ali-Masri H, Bottcher B, Zucknick M, Vikanes A, Hassan S. Impact of animated instruction on tablets and hands-on training in applying bimanual perineal support on episiotomy rates: an intervention study. Int Urogynecol J. 2019 Aug;30(8):1343-1350. doi: 10.1007/s00192-018-3711-6. Epub 2018 Jul 14.

  PMID: 30008080 BACKGROUND

• Ali-Masri H, Hassan S, Ismail K, Zimmo K, Zimmo M, Fosse E, Vikanes A, Laine K. Enhancing recognition of obstetric anal sphincter injuries in six maternity units in Palestine: an interventional quality improvement study. BMJ Open. 2018 Jun 19;8(6):e020983. doi: 10.1136/bmjopen-2017-020983.

  PMID: 29921684 BACKGROUND

• Zimmo M, Laine K, Hassan S, Fosse E, Lieng M, Ali-Masri H, Zimmo K, Anti M, Bottcher B, Sorum Falk R, Vikanes A. Differences in rates and odds for emergency caesarean section in six Palestinian hospitals: a population-based birth cohort study. BMJ Open. 2018 Mar 2;8(3):e019509. doi: 10.1136/bmjopen-2017-019509.

  PMID: 29500211 BACKGROUND

• Hassan S, Vikanes A, Laine K, Zimmo K, Zimmo M, Bjertness E, Fosse E. Building a research registry for studying birth complications and outcomes in six Palestinian governmental hospitals. BMC Pregnancy Childbirth. 2017 Apr 11;17(1):112. doi: 10.1186/s12884-017-1296-6.

  PMID: 28399841 BACKGROUND

• Zimmo K, Laine K, Vikanes A, Fosse E, Zimmo M, Ali H, Thakar R, Sultan AH, Hassan S. Diagnosis and repair of perineal injuries: knowledge before and after expert training-a multicentre observational study among Palestinian physicians and midwives. BMJ Open. 2017 Apr 7;7(4):e014183. doi: 10.1136/bmjopen-2016-014183.

  PMID: 28389490 BACKGROUND

• Ali HY, Vikanes A, Anti M, Hassan S, Ismail KM, Zimmo K, Zimmo M, Fosse E, Laine K. Evaluation of an animated instructional video as a training tool for manual perineum support during vaginal delivery. Int J Gynaecol Obstet. 2017 May;137(2):213-219. doi: 10.1002/ijgo.12115. Epub 2017 Feb 27.

  PMID: 28171679 BACKGROUND

MeSH Terms

Conditions

Obstetric Labor Complications

Condition Hierarchy (Ancestors)

Pregnancy Complications; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases

Study Officials

• Åse Vikanes, PhD

  Oslo University Hospital

  STUDY DIRECTOR

• Erik Fosse, PhD

  Oslo University Hospital, University of Oslo

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor, Head of Department

Study Record Dates

• First Submitted: March 9, 2015
• First Posted: April 28, 2015
• Study Start: February 1, 2015
• Primary Completion: December 31, 2017
• Study Completion: December 31, 2018
• Last Updated: November 29, 2023

Record last verified: 2017-02

Data Sharing

• IPD Sharing: Will not share

Locations

PA (4)