Articles
5 June 2023
Vol. 35 (2023)
https://doi.org/10.4081/uij.2023.299

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

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confidence in repair, obstetric anal sphincter injuries, residents, simulation
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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.

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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

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Residents’ experience and training in obstetric anal sphincter injury repair in the United States. (2023). Urogynaecologia, 35. https://doi.org/10.4081/uij.2023.299
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