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Long-term maternal morbidity after obstetric anal sphincter injury (OASIS) – The Post-OASIS-project

PhD project This research project aims to describe and compare experiences of health, quality of life and work ability 1.5 to five years after childbirth between women with and without maternal morbidity after sustaining an obstetric anal sphincter injury (OASIS). Furthermore, we aim to explore if, how and to what extent maternal morbidity caused by OASIS affects daily life and work ability.

Swedish media and society have lately highlighted maternal morbidity related to OASIS. In Sweden, the Perineal Laceration Registry collects data on perineal tears up to one year postpartum, but several knowledge gaps exist on how and if women´s health, quality of life and work ability are affected by OASIS in a longer time period than the first year postpartum. This project aims to describe and compare experiences of health, quality of life and work ability 1.5 to five years after sustaining an OASIS at childbirth by collecting data via a web-based questionnaire, registries and interviews.

Head of project

Margareta Persson
Associate professor
E-mail
Email

Project overview

Project period:

2020-09-08 2027-12-31

Participating departments and units at Umeå University

Department of Community Medicine and Rehabilitation, Department of Nursing

Research area

Public health and health care science

Project description

Previous research results

Obstetric anal sphincter injuries are detected and sutured in conjunction to childbirth but research has shown that many women suffer from persisting maternal morbidity due to OASIS. Knowledge gaps exist regarding maternal morbidity after OASIS in a Swedish context, but international and some smaller national studies indicate that OASIS can lead to pain, urinary and fecal incontinence, prolaps or sexual problems. Research has shown conflicting results regarding possible impact of maternal morbidity on quality of life, and despite extensive literature search, no studies on effects on work ability after OASIS could be found.  

Rationale

Approximately 25 percent of women with OASIS report persisting maternal morbidity one year post partum in data from the Perineal Laceration Registry. This research project may contribute with novel findings and to fill existing knowledge gaps regarding maternal morbidity after OASIS in a Swedish context.  Moreover, this project aims to improve care for affected women. An additional aim is to illuminate potential consequences for working life as well as possible impact on the sick cash benefit system by identifying potential risk factors regarding maternal morbidity and risk factors for diminished work ability.

Overall aim

This research project aims to describe and compare experiences of health, quality of life and work ability 1.5 to five years after childbirth between women with and without maternal morbidity after sustaining an OASIS. Furthermore, we aim to explore if, how and to what extent maternal morbidity caused by OASIS affects daily life and work ability.

Specific aims

Study I

To describe and compare quality of life 1.5 to five years after OASIS for women with and without maternal morbidity and to identify potential predictors for impaired quality of life.

Study II

To describe and compare work ability for women with and without maternal morbidity caused by OASIS and identify potential predictors for not being able to return to work fully.

Study III

To explore how women with maternal morbidity due to OASIS conceptualize their problems in relation to daily life activities and work ability.

Data collection

This project collects qualitative and quantitative data. In two nationwide studies, women with OASIS are identified through the Medical Birth Registry, a registry containing mandatory information from medical records regarding prenatal care, delivery care as well as neonatal care. Moreover, social media will be used for recruitment of eligible research participants for studies in this project.

Studies 1 and 2 are nationwide cross-sectional studies where data are collected via a web-based questionnaire among a random sample of women with previous OASIS. Additionally, data is collected from registries such as the Medical Birth Registry and the Swedish Social Insurance Agency. The questionnaire consists of background questions and questions regarding potential maternal morbidity after OASIS. Furthermore, the questionnaire covers questions on quality of life and working life. Research participants can decline responding to questions they do not feel comfortable with. The questionnaire can be accessed via a web-link which eligible participants receive via mail.  

Criteria for inclusion and exclusion for study 1 and 2
Women who have given birth vaginally (including instrumental delivery) to at least one living child and sustained OASIS between January 2016 and June 2019.

Eligible participants are identified by a random sample of women with OASIS via the Medical Birth Registry. Women who sustained an OASIS giving birth to a stillborn child or whose child died within 28 days postpartum will be excluded.  

In study 3, interviews will be conducted with women with maternal morbidity after OASIS. Interviews will consist of questions regarding eventual impact on daily life and eventual adjustments of daily life that women have undertaken due to their problems related to OASIS. Moreover, questions on how OASIS has affected women’s work ability and in what way they may have adjusted their working life will be posed. Eligible study participants can register their interest to participate via the research project´s homepage.  Information about the study will be published on social media as well as the research project´s homepage (link provided at the end of this page). A member of the research team will contact interested women in order to provide more information and to assure that inclusion criteria are met. Interviews will be held at a place of the participant’s choice, for example via telephone, face-to-face or via video calls. 

Criteria for inclusion and exclusion for study 3
Women who have given birth vaginally (including instrumental delivery) to at least one living child and sustained an OASIS between January 2016 and June 2019 and experience self-reported maternal morbidity due to OASIS. Excluded are women who sustained an OASIS giving birth to a stillborn child or whose child died within 28 days postpartum, women who still are on parental leave or pregnant at the time for the recruitment.

Data analysis and data handling

All steps of the studies follow the ethical recommendations of the Helsinki declaration and collected data are only accessible to the research group. Each participant will be labelled with a study code. Any personal information, such as names or personal ID-numbers, are kept separate from data sets in a locked space at Umeå university that only the principal investigator has access to. The database, where all data from the web-based questionnaire are stored, is securely stored in a REDCap® research server at Umeå University. Additionally, personal data will be stored and handled according to the General Data Protection Regulation, GDPR. According to ethical guidelines, all collected data will be stored for 10 years.

Collected data will be presented on group level in scientific journals as to further protect the identity of participating women. Neither personal characteristics nor citations will be presented that may reveal the identity of women partaking in the interviews.

Overview of the included studies

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Publications

The findings will be published in peer-reviewed scientific journals with open access. First publications are estimated to be available online by the end of 2021 and additional publications will be presented until the research project is completed. This project may result in about six scientific articles, whereof four studies will be included in the PhD-student’s doctoral thesis.

Study results will be published continuously in this section.

Read more

The MiDAS Registry

Medical Birth Registry

Perineal Laceration Registry

General Data Protection Regulation (GDPR)