Maternal outcomes
Various maternal outcomes are presented in Table 2 . The low
annual volume group had higher rates of any spontaneous perineal tears
(32.3% vs 31.2%, p<0.01) with higher rates of spontaneous
1st and 2nd degree perineal tears
(26.4% and 26.9% vs 25.6% and 25.8% p=0.05 and p=0.01 respectively).
While, they had lower rates of episiotomy (33% vs. 36%,
p<0.01), rates of 3rd and
4th degree perineal tears did not differ. The low
annual volume group had higher rates of manual uterine exploration for
suspected placental products (2.2% vs. 1.9%, p<0.01), yet
rates of manual lysis of the placenta did not differ between the groups.
No differences were noted for other maternal outcomes, including;
shoulder dystocia, PPH, mean hemoglobin drop, blood products
transfusions, endometritis, maternal ICU admissions and prolonged
hospitalization.
Multivariate regressions adjusted for: maternal age, parity, TOLAC,
oxytocin augmentation, persistent occipito-posterior presentation and
CNMs’ practice duration, revealed no significant association between low
annual volume and manual exploration of uterus aOR 1.06, 95% CI
[0.97-1.15].