Skip to main content
SpringerLink
Log in

Structured hands-on training in repair of obstetric anal sphincter injuries (OASIS): an audit of clinical practice

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

An Erratum to this article was published on 02 September 2009

Abstract

We conducted an audit to evaluate how effective a structured course in the management of obstetric anal sphincter injuries (OASIS) was at imparting knowledge. Training was undertaken using models and cadaveric pig’s anal sphincters. An anonymous questionnaire was completed prior to and 8 weeks after the course. Four hundred and ninety seven completed the questionnaire before and 63% returned it after the course. Prior to the course, participants performed on average 14 OASIS repairs independently. Only 13% were satisfied with their level of experience prior to performing their first unsupervised repair. After the course, participants classified OASIS more accurately and changed to evidence-based practice. Particularly, there was a change in identifying (60% vs. 90%; P < 0.0001) and repairing the internal sphincter (60% vs. 90%; P < 0.0001). This audit demonstrated that training in the management of OASIS is suboptimal. Structured training may be effective in changing clinical practice and should be an adjunct to surgical training.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Harkin R, Fitzpatrick M, O’Connell PR, O’Herlihy C (1999) Anal sphincter disruption at vaginal delivery: is recurrence predictable. Eur J Obstet Gynaecol 106:318–323

    Google Scholar 

  2. Coats PM, Chan KK, Wilkins M, Beard RJ (1980) A comparison between midline and mediolateral episiotomies. Br J Obstet Gynaecol 87:408–412

    PubMed  CAS  Google Scholar 

  3. Peleg D, Kennedy CM, Merril D, Zlatnik FJ (1999) Risk of repetition of a severe perineal laceration. Obstet Gynecol 93:1021–1024

    Article  PubMed  CAS  Google Scholar 

  4. Groom KM, Paterson-Brown S (2002) Can we improve on the diagnosis of third degree tears. Eur J Obstet Gynecol Reprod Biol 101:19–21

    Article  PubMed  Google Scholar 

  5. Andrews V, Sultan AH, Thakar R, Jones PW (2006) Occult anal sphincter injuries—myth or reality. Br J Obstet Gynaecol 113:195–200

    Google Scholar 

  6. Sultan AH, Kamm MA, Hudson CN (1995) Obstetric perineal trauma: an audit of training. J Obstet Gynaecol 15:19–23

    Article  Google Scholar 

  7. Fernando R, Sultan AH, Radley S, Jones PW, Johanson RB (2002) Management of obstetric anal sphincter injury: a systematic review and national practice survey. BMC Health Serv Res 2:9

    Article  PubMed  Google Scholar 

  8. Mc Lennan MT, Melick CF, Clancy SL, Artal R (2002) Episiotomy and perineal repair. J Reprod Med 47:1025–1030

    Google Scholar 

  9. Sultan AH, Thakar R (2007) Third and fourth degree tears. In: Sultan AH, Thakar R, Fenner DE (eds) Perineal and anal sphincter trauma. Springer, London, pp 33–51

    Chapter  Google Scholar 

  10. Sultan AH, Thakar R (2002) Lower genital tract and anal sphincter trauma. Best Pract Res Clin Obstet Gynaecol 16:99–115

    Article  PubMed  Google Scholar 

  11. Pinta TM, Kylanpaa M, Salmi TK, Teramo KAW, Luukkonen PS (2004) Primary sphincter repair: are the results of the operation good enough. Dis Colon Rectum 47:18–23

    Article  PubMed  Google Scholar 

  12. Fitzpatrick M, Cassidy M, O’Connell R, O’Herlihy C (2002) Experience with an obstetric perineal clinic. Eur J Obstet Gynecol Reprod Biol 100:199–203

    Article  PubMed  Google Scholar 

  13. Sultan AH, Kettle C (2007) Diagnosis of perineal trauma. In: Sultan AH, Thakar R, Fenner DE (eds) Perineal and anal sphincter trauma. Springer, London, pp 13–19

    Chapter  Google Scholar 

  14. Stepp KJ, Siddiqui NY, Emery SP, Barber MD (2006) Textbook recommendations for preventing and treating perineal injury at vaginal delivery. Obstet Gynecol 107:361–368

    PubMed  Google Scholar 

  15. Fernando R, Sultan AH, Kettle C, Thakar R, Radley S (2006) Methods of repair for obstetric anal sphincter injury. Cochrane Database Syst Rev 3:CD002866

    PubMed  CAS  Google Scholar 

  16. Fernando RJ, Sultan AH, Kettle C, Radley S, Jones P, O’Brien PMS (2006) Repair techniques for obstetric anal sphincter injuries. A randomized controlled trial. Obstet Gynecol 107:1261–1268

    PubMed  Google Scholar 

  17. Fitzpatrick M, Behan M, O’Connell RP, O’Herlihy C (2000) A randomized clinical trial comparing primary overlap with approximation repair of third-degree obstetric tears. Am J Obstet Gynecol 183:1220–1224

    Article  PubMed  CAS  Google Scholar 

  18. Williams A, Adams EJ, Tincello DG, Alfirevic Z, Walkinshaw SA, Richmond DH (2006) How to repair an anal sphincter injury after vaginal delivery: results of a randomized controlled trial. Br J Obstet Gynaecol 113:201–207

    Google Scholar 

  19. Norton C, Christiansen J, Butler U, Harari D, Nelson RL, Pemberton J, Price K, Rovnor E, Sultan A (2002) Anal incontinence. In: Abrams P, Cardozo L, Khoury, Wein A (eds) Incontinence, 2nd edn. Health Publication, Plymouth, pp 985–1044

    Google Scholar 

  20. Royal College of Obstetricians and Gynaecologists (2007) Third- and fourth-degree perineal tears—management. RCOG Guideline No. 29. RCOG, London

    Google Scholar 

  21. Sultan AH, Monga AK, Kumar D, Stanton SL (1999) Primary repair of obstetric anal sphincter rupture using the overlap technique. Br J Obstet Gynaecol 106:318–323

    PubMed  CAS  Google Scholar 

  22. Mahony R, Behan M, Daly L, Kirwan C, O’Herlihy C, O’Connell PR (2007) Internal anal sphincter defect influences continence outcome following obstetric anal sphincter injury. Am J Obstet Gynecol 196:217.e1–217.e5

    Article  Google Scholar 

  23. Siddighi S, Kleeman SD, Baggish MS, Rooney CM, Pauls RN, Karram MM (2007) Effects of an educational workshop on performance of fourth-degree perineal laceration repair. Obstet Gynecol 109:289–294

    PubMed  Google Scholar 

  24. Nichols CM, Lamb EH, Ramakrishnan V (2005) Differences in outcomes after third- versus fourth-degree perineal laceration repair: a prospective study. Am J Obstet Gynecol 193:530–534

    Article  PubMed  Google Scholar 

  25. Phillips RKS, Brown TJ (2007) Surgical management of anal incontinence. Secondary anal sphincter repair. In: Sultan AH, Thakar R, Fenner DE (eds) Perineal and anal sphincter trauma. Springer, London, pp 144–153

    Chapter  Google Scholar 

  26. Royal College of Obstetricians and Gynaecologists (2004) Methods and materials used in perineal repair. RCOG Guideline No. 23. RCOG, London

    Google Scholar 

  27. Goff BA, Lentz GM, Lee D, Morris J, Mandel LS (2000) Development of an objective structured assessment of technical skills for obstetrics and gynecology residents. Obstet Gynecol 96:146–150

    Article  PubMed  CAS  Google Scholar 

  28. Sparks RA, Beesley AD, Jones AD (2006) The “sponge perineum.” An innovative method of teaching fourth-degree obstetric perineal laceration repair to family medicine residents. Fam Med 38:542–544

    PubMed  Google Scholar 

Download references

Conflicts of interest

R.T. and A.H.S. designed the Sultan perineal model which is used in this course and by several others. No royalties are received from the sale of the Sultan perineal model, although 2% of the sale of the blocks is donated to the Mayday Childbirth Charity Fund.

Author information

Authors and Affiliations

  1. Mayday University Hospital, Croydon, CR7 7YE, UK

    Vasanth Andrews, Ranee Thakar & Abdul H. Sultan

Authors
  1. Vasanth Andrews
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ranee Thakar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abdul H. Sultan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ranee Thakar.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00192-009-0986-7

Rights and permissions

Reprints and permissions

About this article

Cite this article

Andrews, V., Thakar, R. & Sultan, A.H. Structured hands-on training in repair of obstetric anal sphincter injuries (OASIS): an audit of clinical practice. Int Urogynecol J 20, 193–199 (2009). https://doi.org/10.1007/s00192-008-0756-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-008-0756-y

Keywords

Search

Navigation