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Awareness Regarding Perineal Protection, Obstetric Anal Sphincter Injury, and Episiotomy Among Obstetrics and Gynecology Residents; Effects of an Educational Workshop

Stecher, Anna, M., MD*; Yeung, Jennifer, DO; Crisp, Catrina, C., MD, MSc; Pauls, Rachel, N., MD

Female Pelvic Medicine & Reconstructive Surgery: May/June 2018 - Volume 24 - Issue 3 - p 241–246
doi: 10.1097/SPV.0000000000000420
Original Articles

Objectives Appropriate perineal protection may reduce rates of obstetric anal sphincter injuries (OASIS). We sought to investigate the knowledge and attitudes of obstetrics and gynecology residents concerning perineal protection, OASIS, and episiotomy before and after an educational workshop.

Methods This was an institutional review board–approved cross-sectional survey study of obstetrics and gynecology residents. Two experts in perineal protection, whose methods have been shown to reduce OASIS by 50%, provided 1 week of education. Residents were taught in hands-on workshops and labor and delivery wards. Residents were surveyed regarding experiences, knowledge, and opinions of perineal protection, OASIS, and episiotomy. Surveys were administered immediately before and after the workshop and at 3 months following.

Results All 31 residents participated. Almost all (97%) felt it was possible to reduce the incidence of OASIS prior to the workshop. Statistically significant increases were noted following training in the number that felt it was “very effective” to use the 2-handed technique taught in the workshop (P = 0.002), as well as those that reported most commonly performing a mediolateral episiotomy (protective against OASIS, if used selectively) when episiotomy was indicated (P = 0.001). The percent that reported feeling “comfortable” or “very comfortable” performing episiotomies increased from 45% to 77% immediately after the workshop (P = 0.002); this declined to 55% at 3 months. A large majority (77%) reported that the workshop was beneficial; 65% described an impact to patient care.

Conclusions A workshop targeting perineal protection improved awareness and changed clinical practice in this group of residents. Ongoing education regarding perineal protection and episiotomy may reinforce behavior modifications.

An educational workshop for obstetrics and gynecology residents regarding perineal protection, obstetric anal sphincter injury, and episiotomy increased awareness in these areas and led to reported changes in patient management.

From the *Department of Obstetrics and Gynecology and †Division of Female Pelvic Medicine and Reconstructive Surgery, TriHealth Good Samaritan Hospital, Cincinnati, OH.

Correspondence: Anna M. Stecher, MD, Department of Obstetrics and Gynecology, Good Samaritan Hospital, 375 Dixmyth Ave, Cincinnati, OH 45220. E-mail: Anna_Stecher@TriHealth.com.

The authors declare that they have nothing to disclose.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.