The Impact of a Nationwide Hands-On Workshop on the Diagnostic Rates and Management of Obstetrical Anal Sphincter Injuries (OASI) In Israel.

OBJECTIVE To evaluate the influence of a half day, hands-on, workshop on detection and repair of Obstetric Anal Sphincter Injuries (OASI). STUDY DESIGN Starting in February 2011, hands-on workshops, for the diagnosis and repair of OASI, were delivered by trained urogynecologists in departments of tertiary medical centers in Israel. The structure of the hands-on workshop resembles the workshop organized at the International Urogynecological Association (IUGA) annual conferences. Participants included medical staff, midwives and surgical residents from each medical center. We collected data regarding the rate of OASI, one year before and one year following the workshop, in eleven medical centers. The study population was comprised of parturients with the following inclusion criteria: singleton pregnancy, vertex presentation and vaginal delivery. Pre-viable preterm gestations (<24 weeks), birth weight <500 g, stillborn, and those with major congenital anomalies, multifoetal pregnancies, breech presentations and caesarean deliveries were excluded from the analysis. RESULTS In the reviewed centers, 70,663 (49.3%) women delivered prior to the workshop (pre-workshop group), and 72,616 (50.7%) women delivered following the workshop (post-workshop group). Third or fourth-degree perineal tears occurred in 248 women (0.35%) before the workshop, and in 328 (0.45%) following the workshop, a significant increase of 28.7% (p = 0.002). The increase in diagnosis was significant also in women with third degree tears alone, 226 women (0.32%) before the workshop and in 298 (0.41%) following the workshop, an increase of 28.3% (p = 0.005). CONCLUSION The detection rate of OASI has significantly increased following the hands on workshop. The implementation of such programs is crucial for increasing awareness and detection rates of OASI following vaginal deliveries.