https://doi.org/10.4081/uij.2023.299

Residents’ experience and training in obstetric anal sphincter injury repair in the United States

Vol. 35 No. 1 (2023)
Submitted: 1 November 2022
Accepted: 18 May 2023
Published: 5 June 2023
confidence in repair, obstetric anal sphincter injuries, residents, simulation
Abstract Views: 767
PDF: 181
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Sujatha Narayanamoorthy
snarayanamoorthy@maimonidesmed.org
https://orcid.org/0000-0001-8923-5348
Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York, United States.
Kimen Singh Balhotra
Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York, United States.
Michael Silver
Research Administration, Maimonides Medical Center, Brooklyn, New York, United States.
Rodney McLaren Jr.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
Elishia McKay
Division of Female Pelvic Medicine and Reconstructive Surgery, Maimonides Medical Center, Brooklyn, New York, United States.

With the reduction in obstetric anal sphincter injuries (OASIS) cases, it is unknown if learning and exposure to their repair is compromised during obstetrics and gynecology (OBGYN) residency in the United States (US). The aim of this study was to evaluate the exposure and confidence level of the US OBGYN residents to OASIS repair. Residents’ education on OASIS repair was also assessed. This was a cross sectional online survey that collected residents’ demographics, characteristics of residency program, the number of deliveries and OASIS repairs performed, the site and technique of OASIS repair, post-repair care provided, residents’ confidence level in OASIS repair and their education on the repair. Descriptive analyses, Fisher’s Exact tests, Ordinal regression models and Spearman’s correlation were performed. Response from 160 residents (11% response rate) was obtained. Confidence was higher with increasing level of training (OR = 3.442, 95% CI, 2.473-4.791, p<0.004), a greater number of deliveries (OR=2.672, 95% CI, 1.511-4.723, p<0.001), third-degree repairs (OR=5.522, 95%CI, 3.67-8.308, p<0.001) and fourth-degree repairs (OR=4.364, 95% CI, 2.785-6.837, p<0.001) performed. Exposure to lecture or/and simulation improved confidence than no exposure to either (OR= 0.225, 95% CI, 0.092-0.545, p<0.001). Residents’ confidence level increased with a greater number of simulations attended (r=0.368, p< 0.001). Lectures and simulations enhance residents’ knowledge and skills in OASIS repair. Surgical skill curriculum is essential to maintain good quality training, prompt recognition, and meticulous perineal repair among OBGYN physicians despite the declining OASIS cases.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Harvey MA, Pierce M, Walter JE, et al. Society of Obstetricians and Gynaecologists of Canada. Obstetrical Anal Sphincter Injuries (OASIS): Prevention, Recognition, and Repair. J Obstet Gynaecol Can 2015;37:1131-48. DOI: https://doi.org/10.1016/S1701-2163(16)30081-0
Andrews V, Sultan AH, Thakar R, Jones PW. Occult anal sphincter injuries--myth or reality? BJOG 2006;113:195-200. DOI: https://doi.org/10.1111/j.1471-0528.2006.00799.x
Reid AJ, Beggs AD, Sultan AH, et al. Outcome of repair of obstetric anal sphincter injuries after three years. Int J Gynaecol Obstet 2014;127:47-50. DOI: https://doi.org/10.1016/j.ijgo.2014.04.013
Bellussi F, Dietz HP. Postpartum ultrasound for the diagnosis of obstetrical anal sphincter injury. Am J Obstet Gynecol MFM 2021;3:100421. DOI: https://doi.org/10.1016/j.ajogmf.2021.100421
Minaglia SM, Özel B, Gatto NM, et al. Decreased rate of obstetrical anal sphincter laceration is associated with change in obstetric practice. Int Urogynecol J Pelvic Floor Dysfunct 2007;18:1399-04. DOI: https://doi.org/10.1007/s00192-007-0353-5
Best C, Drutz HP, Alarab M. Obstetric anal sphincter injuries: a survey of clinical practice among Canadian obstetricians. J Obstet Gynaecol Can 2012;34:747-54. DOI: https://doi.org/10.1016/S1701-2163(16)35338-5
Andrews V, Thakar R, Sultan AH. Structured hands-on training in repair of obstetric anal sphincter injuries (OASIS): an audit of clinical practice. Int Urogynecol J Pelvic Floor Dysfunct 2009;20:193-9. DOI: https://doi.org/10.1007/s00192-008-0756-y
Ginath S, Alcalay M, Ben Ami M, et al. The impact of a nationwide hands-on workshop on the diagnostic rates and management of obstetrical anal sphincter Injuries in Israel. Colorectal Dis 2020;22:1677-85. DOI: https://doi.org/10.1111/codi.15220
Ali-Masri H, Hassan S, Ismail K, et al. Enhancing recognition of obstetric anal sphincter injuries in six maternity units in Palestine: an interventional quality improvement study. BMJ Open 2018;19:8(6)-e020983. DOI: https://doi.org/10.1136/bmjopen-2017-020983
Sultan AH, Thakar R. Third and fourth degree tears. In: Sultan AH, Thakar R, Fenner DE, eds. Perineal and anal sphincter trauma. London: Springer 2007;33–51. DOI: https://doi.org/10.1007/978-1-84628-503-5_4
Emmanuelli V, Lucot JP, Closset E, et al. Élaboration et évaluation d'un outil d'enseignement de la réparation des déchirures périnéales du troisième et quatrième degré [Development and assessment of a workshop on repair of third and fourth degree obstetric tears.] J Gynecol Obstet Biol Reprod (Paris) 2013;42:184-190. DOI: https://doi.org/10.1016/j.jgyn.2012.12.011
Eston M, Stephenson-Famy A, McKenna H, Fialkow M. Perineal Laceration and Episiotomy Repair Using a Beef Tongue Model. MedEdPORTAL 2020;14;16:10881. DOI: https://doi.org/10.15766/mep_2374-8265.10881
Illston JD, Ballard AC, Ellington DR, Richter HE. Modified beef tongue model for fourth-degree laceration repair simulation. Obstet Gynecol 2017;129:491-6. DOI: https://doi.org/10.1097/AOG.0000000000001908
Zimmo K, Laine K, Vikanes Å, et al. Diagnosis and repair of perineal injuries: knowledge before and after expert training-a multicentre observational study among Palestinian physicians and midwives. BMJ Open 2017;7:e014183. DOI: https://doi.org/10.1136/bmjopen-2016-014183
Taithongchai A, Veiga SI, Sultan AH, Thakar R. The consequences of undiagnosed obstetric anal sphincter injuries (OASIS) following vaginal delivery. Int Urogynecol J 2020;31:635-41. DOI: https://doi.org/10.1007/s00192-019-04033-5
Walsh KA, Grivell RM. Use of endoanal ultrasound for reducing the risk of complications related to anal sphincter injury after vaginal birth. Cochrane Database Syst Rev 2015;10:CD010826. DOI: https://doi.org/10.1002/14651858.CD010826.pub2

How to Cite

Narayanamoorthy, S., Balhotra, K. S., Silver, M., McLaren Jr., R., & McKay, E. (2023). Residents’ experience and training in obstetric anal sphincter injury repair in the United States. Urogynaecologia, 35(1). https://doi.org/10.4081/uij.2023.299
Copyright (c) 2023 the Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.

An Open Access Publication is one that meets the following two conditions:

  1. the author(s) and copyright holder(s) grant(s) to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship, as well as the right to make small numbers of printed copies for their personal use.
  2. a complete version of the work and all supplemental materials, including a copy of the permission as stated above, in a suitable standard electronic format is deposited immediately upon initial publication in at least one online repository that is supported by an academic institution, scholarly society, government agency, or other well-established organization that seeks to enable open access, unrestricted distribution, interoperability, and long-term archiving.

Authors who publish with this journal agree to the following terms:

  1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
  2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
  3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.

Similar Articles

1 2 3 4 > >> 

You may also start an advanced similarity search for this article.