Program
Tuesday, May 28, 2013
Protect- Train the Trainer Program
1:00 pm – 5:00 pm
Chairs: Dr. Ranee Thakar and Dr. Abdul Sultan
Max Capacity: 40 people (first come first served)
For those who are interested in attending PROTECT, please contact registration@iuga.org

Steering Group: Ranee Thakar (UK) Abdul Sultan (UK) Montse Espuna (Spain) Jan Willem De Leeuw (Netherlands) Conrad Marzik (Argentina) Aparecida Pacetta (Brazil) Rajmaheshwari (India) Catherine Matthews (USA) Zeelha Abdool (South Africa) Teresa Mascarenhas (Portugal)

Module contributors: Catherine Matthews Jan Willem De Leeuw Zeelha Abdool Abdul Sultan Ranee Thakar

Goal:
To promote knowledge of obstetricians and midwives worldwide in the management of perineal trauma and episiotomy through structured training with a view to minimising pelvic floor and perineal morbidity associated with childbirth.

Objective:
To minimise pelvic floor and perineal morbidity associated with childbirth. In order to attend this program you must meet the following criteria:

• Members will need to take the test module and pass
• Will need to attend a OASIS hands-on repair workshop within the last 2 years

Session will have a maximum of 50 participants.

Background:
Perineal repair after childbirth affects millions of women worldwide. In the United Kingdom approximately 85% of women sustain some form of perineal trauma during vaginal delivery and of these 69% will require suturing [1]. The prevalence of perineal trauma varies as it is dependent on obstetric practice including rates and types of episiotomy [2].

Obstetric anal sphincter injuries (OASIS) occur in 1.7% (2.9% in primiparae) [3] of woman in centers where mediolateral episiotomies are practised compared to 12% [4] to 19% [5] (19% in primiparae) in centers practising midline episiotomy. Unfortunately it has been shown previously that up to half of OASIS are not recognised by the accoucher [6,7]. Inadequate training of doctors and midwives in perineal and anal sphincter anatomy [8] is believed to be a major contributing factor. In a survey of 75 doctors and 75 midwives in the United Kingdom, Sultan et al demonstrated inconsistencies in the classification of perineal trauma, as one third of doctors were classifying third degree tears as second degree tears [8]. Most trainee doctors admitted that their training in recognising (84%) and repairing (94%) OASIS was poor. Furthermore in another study 64% of consultants reported unsatisfactory or no training in the management of OASIS [9]. McLennan et al also raised concern about training in the USA. They surveyed 1,177 fourth year residents and found that the majority of residents had received no formal training in pelvic floor anatomy, episiotomy or perineal repair, and supervision during perineal repair was limited [10].

However despite recognition and primary repair of acute OASIS, 39 to 61% [11,12,13] have symptoms of anal incontinence and 92% have persistent anal sphincter defects on ultrasound [14] within 3 months of delivery. The morbidity associated with perineal trauma depends on the extent of perineal damage, technique and materials used for suturing and the skill of the person performing the procedure. It is therefore important that practitioners ensure that procedures such as perineal repair, are evidence-based in order to provide care that is effective, appropriate and cost-efficient [15]. Unfortunately, there is no standardised approach to prevention and repair of perineal trauma and episiotomy.

Based on this background, in 2000, Sultan and Thakar developed the first international hands-on course for repair and diagnosis of perineal and obstetric anal sphincter trauma (16,17). Two surveys of midwives and doctors conducted a few months after attending the course have indicated that there was an improvement in diagnosis and repair of perineal and anal sphincter trauma [16,17], Based on this experience we would like to develop a worldwide program to improve knowledge in this area.

PROTECT Disclaimer:

I understand that completion of this IUGA sponsored educational activity in no way implies that IUGA has endorsed, certified, qualified or licensed me, or other health care professionals I will teach or supervise. The IUGA logo and the PROTECT name may not be used in the promotion of educational activities organized outside the framework of IUGA's annual meetings, regional symposia, exchange programs, online courses and other IUGA sponsored educational activities. I may, after completing all PROTECT modules, signify myself as a 'PROTECT trained trainer'. All courses I organize, supervise or teach using this signifier should be free of charge, and be reported to the IUGA office. I agree to audit change in practice by ensuring delegates complete a PROTECT pre-course questionnaire which will be repeated after 3 months.