Diagnosis, management and training in perineal trauma: a UK national survey of obstetricians

Abstract

Introduction and hypothesis Perineal trauma during vaginal delivery is very common. Training in diagnosis and repair of trauma, including obstetric anal sphincter injuries, varies in the UK. We aimed to investigate the current knowledge and training received by obstetric physicians. Methods A national, validated survey was conducted online, using Qualtrics. The National Trainees Committee distributed the survey. It was also sent directly to consultants via email. Results A total of 302 physicians completed the survey and were included in the analysis. 3.9% of participants described their training in obstetric perineal trauma as “very poor” or “poor”. 20.5% said they have not received training. 8.6% of physicians practising for more than 10 years had not had training for over 10 years. 70.5% responded “somewhat agree” or “strongly agree” when asked if they would like more training. Identification of first, second, third-, and fourth-degree tears from images and descriptions was very good (more than 80% correct for all categories). Classification of other perineal trauma was less consistent, with many incorrectly using the Sultan Classification. “Manual perineal support” and “Controlled or guided delivery” were the most frequently selected methods for the prevention of obstetric anal sphincter injury (OASI). Conclusions Training experience for physicians in obstetric perineal trauma varies. Further improvement in training and education in perineal trauma, particularly in OASI, is needed for physicians. Perineal trauma that is not included in the Sultan Classification is often misclassified.

UK survey of colorectal surgeons on the management of acute obstetric anal sphincter injuries

“…With the experience that colorectal surgeons undoubtedly have in anorectal anatomy, their assistance could be beneficial during difficult cases of OASI repair. The focus of improved OASI care in the last 20 years has been the education of obstetricians and midwives, which has resulted in an improvement in knowledge of OASI [19,24]. We suggest that collaborative training of obstetricians and colorectal surgeons could lead to more collaborative, specially selected cases and possibly better outcomes, but this remains to be proven.…”

“…This may be a particular group of patients who would benefit from collaboration with colorectal surgeons, given the rarity of these cases and therefore relatively less experience that obstetricians have [15,19].…”