title: Diagnosis and repair of perineal injuries: knowledge before and after expert training-a multicentre observational study among Palestinian physicians and midwives.
abstract: To assess whether a 2 days training with experts teaching on diagnosis and repair of perineal injuries among Palestinian midwives and physicians could change their level of knowledge towards the correct diagnosis and treatment.
  
  
  
  Multicentre observational study.
  
  
  
  Obstetric departments in 6 government Palestinian hospitals.
  
  
  
  All physicians and midwives who attended the training.
  
  
  
  A questionnaire comprising of 14 questions on the diagnosis and repair of perineal tears was distributed to all participants before the training (n=150; 64 physicians and 86 midwives) and 3 months after the training (n=124, 53 and 71, respectively). Characteristics, differences of the study population and level of knowledge before and after the training were presented as frequencies and percentages. Consistency in responses was tested by estimating the p value of McNemar test.
  
  
  
  Among physicians only 11.4% had accurate knowledge on perineal anatomy before the training compared with 78.85% after the training (p<0.001). For midwives, the corresponding numbers were 9.8% and 54.2%, respectively (p<0.001). Before the training, 5.8% of the physicians were aware that rectal examination is mandatory before and after suturing of episiotomies compared with 45.8% after the training (p<0.001). The corresponding numbers for midwives were 0% and 18% (p<0.001), respectively. Physicians knowledge of best practice of skin repair following episiotomy improved from 36.5% to 64.5% (p=0.008) and among midwives from 26.1% to 50.7% (p<0.001). Physicians knowledge of the overlap technique in the repair of full thickness external anal sphincter tears improved from 28.5% to 42.8% (p=0.05), whereas knowledge of repairing torn internal anal sphincter separately improved from 12.8% to 86.8% (p<0.001).
  
  
  
  Improvement in the level of knowledge on diagnosis and repair of perineal tears was observed for all physicians and midwives who attended the 2 days' expert training. Regular ongoing training will serve to maintain the newly acquired knowledge.
authors.affiliation: Department of Obstetrics, Al Aqsa Hospital, Gaza, Palestine.|Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.|The Intervention Centre, Oslo University Hospital Rikshospitalet, Oslo, Norway.
authors.forename: Kaled
authors.initials: K
authors.lastname: Zimmo
authors.affiliation: Department of Obstetrics, Oslo University Hospital, Oslo, Norway.
authors.forename: Katariina
authors.initials: K
authors.lastname: Laine
authors.affiliation: The Intervention Centre, Oslo University Hospital Rikshospitalet, Oslo, Norway.
authors.forename: Åse
authors.initials: Å
authors.lastname: Vikanes
authors.affiliation: Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.|The Intervention Centre, Oslo University Hospital Rikshospitalet, Oslo, Norway.
authors.forename: Erik
authors.initials: E
authors.lastname: Fosse
authors.affiliation: Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.|The Intervention Centre, Oslo University Hospital Rikshospitalet, Oslo, Norway.|Department of Obstetrics, Al Shifa Hospital, Gaza, Palestine.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Zimmo
authors.affiliation: Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.|The Intervention Centre, Oslo University Hospital Rikshospitalet, Oslo, Norway.|Department of Obstetrics, Palestine Medical Complex Hospital, Ramallah, Palestine.
authors.forename: Hadil
authors.initials: H
authors.lastname: Ali
authors.affiliation: Croydon University Hospital, Croydon, UK.
authors.forename: Ranee
authors.initials: R
authors.lastname: Thakar
authors.affiliation: Croydon University Hospital, Croydon, UK.
authors.forename: Abdul H
authors.initials: AH
authors.lastname: Sultan
authors.affiliation: Faculty of Nursing, Pharmacy and Health Professions, Birzeit University, Ramallah, Palestine.|Institute of Community and Public Health, Birzeit University, Ramallah, Palestine.
authors.forename: Sahar
authors.initials: S
authors.lastname: Hassan
mesh_terms: D001003:Anal Canal / Q000293:injuries* / Q000601:surgery; D002983:Clinical Competence; D051517:Digital Rectal Examination; D004841:Episiotomy / Q000379:methods*; D005260:Female; D006801:Humans; D022125:Lacerations / Q000175:diagnosis* / Q000601:surgery; D008877:Middle East; D008880:Midwifery / Q000193:education*; D007744:Obstetric Labor Complications / Q000175:diagnosis* / Q000601:surgery; D009774:Obstetrics / Q000193:education*; D010502:Perineum / Q000293:injuries* / Q000601:surgery; D010820:Physicians; D011247:Pregnancy; D013536:Suture Techniques
keywords: Episiotomy; Midwives; OASIS; Perineal trauma; Physicians