Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Feb;115(2 Pt 1):305-309.
doi: 10.1097/AOG.0b013e3181c8b4f7.

Resident competency in obstetric anal sphincter laceration repair

Shitanshu Uppal  1 , Oz Harmanli, Jennifer Rowland, Enrique Hernandez, Vani Dandolu
Affiliations

Resident competency in obstetric anal sphincter laceration repair

Shitanshu Uppal et al. Obstet Gynecol. 2010 Feb.

Abstract

Objective: To estimate objectively the proficiency of obstetrican-gynecologist (ob-gyn) residents in third-degree perineal tear repair.

Methods: A total of 40 ob-gyn residents from 13 residency programs demonstrated their technique of perineal laceration repair on a modified beef tongue model. Two faculty members with expertise in repairing obstetric anal sphincter injury evaluated the residents using a checklist. The checklist identified three key steps of the procedure, including 1) repair of the internal anal sphincter; 2) selection of proper suture material; and 3) repair of the external anal sphincter, further evaluated using three subcomponents.

Results: The overall pass rate was 42.5% (17/40). Many residents missed critical steps of the repair. Year of training (P=.763), parent residency program (P=.5), and prior experience (P=.48) had no significant effect on the pass rate. There was greater than 90% concordance between the evaluators (r=0.9, P<.001). Satisfaction with the modified beef tongue model was higher than with current training methods in their program (7.81 compared with 6.92 on a scale of 1-10, P=.001).

Conclusion: Ob-gyn residents demonstrated substandard skill in repairing anal sphincter laceration. The low pass rate of 42.5% suggests lack of adequate training in repair. The model had a high resident satisfaction, and high interobserver correlation was noted using the checklist. Thus, identification and evaluation of key steps using a standardized checklist may lead to standardization of repair and ensures consistency and quality.

Level of evidence: III.

PubMed Disclaimer

References

    1. Angioli R, Gómez-Marín O, Cantuaria G, O'sullivan M. Severe perineal lacerations during vaginal delivery: the University of Miami experience. Am J Obstet Gynecol 2000;182:1083–5.
    1. Robinson JN, Norwitz ER, Cohen AP, McElrath TF, Lieberman ES. Episiotomy, operative vaginal delivery, and significant perinatal trauma in nulliparous women. Am J Obstet Gynecol 1999;181:1180–4.
    1. Green JR, Soohoo SL. Factors associated with rectal injury in spontaneous deliveries. Obstet Gynecol 1989;73:732–8.
    1. Peleg D, Kennedy CM, Merrill D, Zlatnik FJ. Risk of repetition of a severe perineal laceration. Obstet Gynecol 1999;93:1021–4.
    1. Handa VL, Danielsen BH, Gilbert WM. Obstetric anal sphincter lacerations. Obstet Gynecol 2001;98:225–30.