Confidence in repair of obstetric anal sphincter injuries and objective assessment in obstetricians

Gnankang Sarah Napoé,Caroline E Foust-Wright,Rebecca Posthuma Batalden,Alex Melamed,Samantha J Pulliam,Lori R Berkowitz

doi:10.15761/cogrm.1000128

Abstract

Objective: To describe attending obstetricians’ self-reported confidence to recognize and repair Obstetric Anal Sphincter Injuries (OASIS), assess knowledge of anatomy and risk factors for OASIS and evaluate the need for a protocol. Study design: A questionnaire was distributed to attending obstetricians at seven major medical centers. The survey was divided into categories including demographics, self-reported confidence at recognition of OASIS, self–reported competence at OASIS repair, questions on anatomy and risk factors for OASIS and need for a protocol for OASIS repair. Results: We collected 82 questionnaires for a response rate of 40.2 percent. Twenty-two (26.8%) and 59 (72%) survey respondents were respectively mostly confident or very confident and only one (1.2%) was somewhat confident at OASIS recognition. Thirty-two (39%) participants felt mostly competent, and 47 (57.3%) felt very competent at OASIS repairs. Percentage of correct answers to the objective questions on anatomy and risk factors ranged from 45.1 to 58.5. Overall performance in objective questions did not differ by self-reported competence in repair of higher order lacerations (p=0.09). Conclusions: Our study shows that self-reported confidence in detecting OASIS and competence in repair of OASIS does not correlate with knowledge of anatomy and risk factors of OASIS.

Highlights

Obstetric anal sphincter injuries (OASIS) which include third and fourth degree lacerations are estimated to occur in 3.3 to 11% of vaginal deliveries [1,2,3]
Attending obstetricians self-reported confidence at Obstetric Anal Sphincter Injuries (OASIS) recognition and repair compared with objective measurement of OASIS knowledge
A 2002 study by McLennan et al [6] surveying more than 1100 fourth year Obstetrics and Gynecology (OBGYN) residents in the United States revealed that 60% of respondents had not received formal education about the repair of perineal lacerations and less than 30% of third degree lacerations were repaired under the supervision of an attending physician [6]

Summary

Introduction

Obstetric anal sphincter injuries (OASIS) which include third and fourth degree lacerations are estimated to occur in 3.3 to 11% of vaginal deliveries [1,2,3]. Their occurrence is associated with long-term sequelae including flatal and fecal incontinence as well as decrease in sexual function [4,5]. Given their lasting impact on women’s quality of life, it is imperative to recognize OASIS at the time of delivery, and to repair them appropriately. A survey of practicing obstetricians and obstetricians-in-training in the United Kingdom demonstrated that obstetricians-in-training were more likely to know the definition of an OASIS compared to practicing obstetricians [8]

Methods

Results

Conclusion