Skip to main content
Top
Published in: The Journal of Obstetrics and Gynecology of India 1/2024

09-10-2023 | Perineal Laceration | Original Article

Structured Workshop for Repair of High-Grade Perineal Lacerations Among Obstetrics and Gynecology Residents, The Need for Repetition and Retraining

Authors: Zinat Ghanbari, M.D., Arefeh Eshghinejad, M.D., Marjan Ghaemi, M.D., Alireza Hadizadeh, M.D., Khadijeh Adabi, M.D., Nafiseh Hivechi, M.D., Maryam Yazdizadeh, M.D., Maryam Deldar Pasikhani, M.D.

Published in: The Journal of Obstetrics and Gynecology of India | Issue 1/2024

Login to get access

Abstract

Objective

The objective of this study was to evaluate the effectiveness of structured workshops in improving the knowledge and skills of obstetrics and gynecology residents for repairing high-grade perineal lacerations.

Materials and methods

This quasi-experimental multicenter study evaluated the baseline knowledge of obstetrics and gynecology residents using an online patient-management problem (PMP) tool. After the initial evaluation, a workshop was conducted using sponge models to teach the practical technique for repairing high-grade perineal lacerations, including external and internal anal sphincter repair. The residents' knowledge was reassessed by PMP exams at 3 and 6 months after the workshop, and the scores were compared to the baseline statistics.

Result

Eighty residents participated in the study, including 26, 22, and 32 at the first, second, and third-year levels of residency, respectively. The total PMP scores significantly improved after three months of the workshop, with an increasing total score from 15.5 (baseline) to 31.3 (p = 0.027) (range of total score from − 63 to + 52). The senior residents performed better before and after three months of the intervention. However, in the six-month follow-up, the total PMP score of all residents decreased to 12.3 with no significant difference with pre-education scores at all levels. Similar significant results were also reported for each PMP question at all levels of residency.

Conclusion

The study found that obstetrics and gynecology residents had substandard knowledge in repairing perineal lacerations. Although the training workshop significantly increased residents' knowledge, its effectiveness diminished over time, indicating a need for continuous or periodic training.
Appendix
Available only for authorised users
Literature
1.
go back to reference Jangö H, Langhoff-Roos J, Rosthøj S, Saske A. Long-term anal incontinence after obstetric anal sphincter injury—does grade of tear matter? Am J Obstet Gynecol. 2018;218(2):232.CrossRef Jangö H, Langhoff-Roos J, Rosthøj S, Saske A. Long-term anal incontinence after obstetric anal sphincter injury—does grade of tear matter? Am J Obstet Gynecol. 2018;218(2):232.CrossRef
2.
go back to reference McLennan MT, Melick CF, Clancy SL, Artal R. Episiotomy and perineal repair. An evaluation of resident education and experience. J Reproduct Med. 2002;47(12):1025–30. McLennan MT, Melick CF, Clancy SL, Artal R. Episiotomy and perineal repair. An evaluation of resident education and experience. J Reproduct Med. 2002;47(12):1025–30.
3.
go back to reference Gjessing H, Backe B, Sahlin Y. Third degree obstetric tears; outcome after primary repair. Acta Obstet Gynecol Scand. 1998;77(7):736–40.CrossRefPubMed Gjessing H, Backe B, Sahlin Y. Third degree obstetric tears; outcome after primary repair. Acta Obstet Gynecol Scand. 1998;77(7):736–40.CrossRefPubMed
4.
go back to reference Fenner DE, Genberg B, Brahma P, Marek L, DeLancey JO. Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol. 2003;189(6):1543–9.CrossRefPubMed Fenner DE, Genberg B, Brahma P, Marek L, DeLancey JO. Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol. 2003;189(6):1543–9.CrossRefPubMed
5.
go back to reference Cornet A, Porta O, Pineiro L, Ferriols E, Gich I, Calaf J. Management of obstetric perineal tears: do obstetrics and gynaecology residents receive adequate training? Results of an anonymous survey. Obstet Gynecol Int. 2012;2012. Cornet A, Porta O, Pineiro L, Ferriols E, Gich I, Calaf J. Management of obstetric perineal tears: do obstetrics and gynaecology residents receive adequate training? Results of an anonymous survey. Obstet Gynecol Int. 2012;2012.
6.
go back to reference Brazell H, Wheeler T, Swift S. Assessing the impact of repeated simulation of 4th degree lacerations on resident competency. Obstet Gynecol. 2018;132:53S.CrossRef Brazell H, Wheeler T, Swift S. Assessing the impact of repeated simulation of 4th degree lacerations on resident competency. Obstet Gynecol. 2018;132:53S.CrossRef
7.
go back to reference Turel FD, Langer S, Shek KL, Dietz HP. Medium-to long-term follow-up of obstetric anal sphincter injury. Dis Colon Rectum. 2019;62(3):348–56.CrossRefPubMed Turel FD, Langer S, Shek KL, Dietz HP. Medium-to long-term follow-up of obstetric anal sphincter injury. Dis Colon Rectum. 2019;62(3):348–56.CrossRefPubMed
8.
go back to reference Krause HG, Wong V, Ng SK, Tan GI, Goh JT. Pelvic floor ultrasound findings in Ugandan women with obstetric fistula, unrepaired fourth degree obstetric tear, and pelvic organ prolapse. Aust N Z J Obstet Gynaecol. 2019;59(4):585–9.CrossRefPubMed Krause HG, Wong V, Ng SK, Tan GI, Goh JT. Pelvic floor ultrasound findings in Ugandan women with obstetric fistula, unrepaired fourth degree obstetric tear, and pelvic organ prolapse. Aust N Z J Obstet Gynaecol. 2019;59(4):585–9.CrossRefPubMed
9.
go back to reference Dancz CE, Sun V, Moon HB, Chen JH, Özel B. Comparison of 2 simulation models for teaching obstetric anal sphincter repair. Simulation in Healthcare. 2014;9(5):325–30.CrossRefPubMed Dancz CE, Sun V, Moon HB, Chen JH, Özel B. Comparison of 2 simulation models for teaching obstetric anal sphincter repair. Simulation in Healthcare. 2014;9(5):325–30.CrossRefPubMed
10.
go back to reference Okeahialam NA, Thakar R, Sultan AH. Early secondary repair of obstetric anal sphincter injuries (OASIs): experience and a review of the literature. Int Urogynecol J. 2021;32(7):1611–22.CrossRefPubMed Okeahialam NA, Thakar R, Sultan AH. Early secondary repair of obstetric anal sphincter injuries (OASIs): experience and a review of the literature. Int Urogynecol J. 2021;32(7):1611–22.CrossRefPubMed
11.
go back to reference Diaz MP, Simpson N, Brown A, Diorgu FC, Steen M. Effectiveness of structured education and training in perineal wound assessment and repair for midwives and midwifery students: A review of the literature. Eur J Midwifery. 2021;5. Diaz MP, Simpson N, Brown A, Diorgu FC, Steen M. Effectiveness of structured education and training in perineal wound assessment and repair for midwives and midwifery students: A review of the literature. Eur J Midwifery. 2021;5.
12.
go back to reference Arnold MJ, Sadler K, Leli K. Obstetric lacerations: prevention and repair. Am Fam Physician. 2021;103(12):745–52.PubMed Arnold MJ, Sadler K, Leli K. Obstetric lacerations: prevention and repair. Am Fam Physician. 2021;103(12):745–52.PubMed
13.
go back to reference Ginath S, Alcalay M, Ben Ami M, Bssam Abbas Y, Cohen G, Condrea A, et al. The impact of a nationwide hands-on workshop on the diagnostic rates and management of obstetrical anal sphincter Injuries in Israel. Colorectal Disease. 2020;22(11):1677–85.CrossRefPubMed Ginath S, Alcalay M, Ben Ami M, Bssam Abbas Y, Cohen G, Condrea A, et al. The impact of a nationwide hands-on workshop on the diagnostic rates and management of obstetrical anal sphincter Injuries in Israel. Colorectal Disease. 2020;22(11):1677–85.CrossRefPubMed
14.
go back to reference Siddighi S, Kleeman SD, Baggish MS, Rooney CM, Pauls RN, Karram MM. Effects of an educational workshop on performance of fourth-degree perineal laceration repair. Obstet Gynecol. 2007;109(2 Pt 1):289–94.CrossRefPubMed Siddighi S, Kleeman SD, Baggish MS, Rooney CM, Pauls RN, Karram MM. Effects of an educational workshop on performance of fourth-degree perineal laceration repair. Obstet Gynecol. 2007;109(2 Pt 1):289–94.CrossRefPubMed
Metadata
Title
Structured Workshop for Repair of High-Grade Perineal Lacerations Among Obstetrics and Gynecology Residents, The Need for Repetition and Retraining
Authors
Zinat Ghanbari, M.D.
Arefeh Eshghinejad, M.D.
Marjan Ghaemi, M.D.
Alireza Hadizadeh, M.D.
Khadijeh Adabi, M.D.
Nafiseh Hivechi, M.D.
Maryam Yazdizadeh, M.D.
Maryam Deldar Pasikhani, M.D.
Publication date
09-10-2023
Publisher
Springer India
Published in
The Journal of Obstetrics and Gynecology of India / Issue 1/2024
Print ISSN: 0971-9202
Electronic ISSN: 0975-6434
DOI
https://doi.org/10.1007/s13224-023-01792-6

Other articles of this Issue 1/2024

The Journal of Obstetrics and Gynecology of India 1/2024 Go to the issue