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  1. Home
  2. Tools
  3. PROTECT

PROTECT: Prevention and Repair Of perineal Trauma Episiotomy through Coordinated Training

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Organizers

Abdul Sultan (United Kingdom)
Ranee Thakar (United Kingdom)

Steering Group 

Jan Willem De Leeuw (Netherlands)
Natarajan Rajmaheswari (India)
Nicola Adanna Okeahialam ( (United Kingdom)
Svjetlana Lozo (USA)

PROTECT is a “train the trainer” program, with the main goal being to promote knowledge of obstetricians and midwives globally in the management of perineal trauma and episiotomy through structured training with a view to minimizing pelvic floor and perineal morbidity associated with childbirth. 

To become a PROTECT-trained trainer the individual must successfully complete the PROTECT 4-Step process outlined below. Trainers acknowledge that completion of PROTECT in no way implies that IUGA has endorsed, certified, qualified or licensed them. Following successful completion of the program, trainers may signify they are a “PROTECT-trained trainer” for any OASIS course they teach or supervise. Trainers may not use the IUGA logo or the PROTECT name or logo in the promotion of any educational activities they organize outside the framework of IUGA's Annual Meetings, Regional Symposia, eXchange Programs, online courses or other IUGA-sponsored educational activities.

All PROTECT-trained trainers agree to 1) maintain their membership in IUGA as long as they are using the PROTECT-trained trainer designation, 2) provide the IUGA Office with notification of all OASIS courses they organize, supervise or teach using the PROTECT signifier, 3) provide the IUGA Office with course rosters of all course participants so that individuals’ progress through the PROTECT program may be tracked, and 4) audit change in practice by ensuring their course attendees complete a PROTECT pre-course questionnaire and a post-course questionnaire administered 3 months after their course.

Four-Step Process:

  1. Successfully complete the Theoretical Test*
  2. Attend the OASIS Hands-on Workshop at the IUGA Annual Meeting or one conducted by a PROTECT-trained trainer.*
  3. Attend the IUGA-sponsored PROTECT Workshop within 2 years of completing Step 2. Training must include teaching of episiotomy repair.
  4. Upload personal videos demonstrating your live surgical technique within 2 years of completing Step 2. More information on video submission can be found here.

*Steps 1 and 2 may be completed in any order.

Following successful completion of these 4 steps, participants will be awarded a certificate of completion of the PROTECT program. For more information, please contact the IUGA Executive Office (This email address is being protected from spambots. You need JavaScript enabled to view it.).

IUGA congratulates the following individuals who have successfully completed the program:

Manisha Yadav (Nepal) - May 2026
Shasindran Ramanujam (Malaysia) - May 2025
Nikola Okeahialam (United Kingdom) - January 2024
Leonie de Jong-Speksnijder (The Netherlands) - August 2023
Shimon Ginath (Israel) - December 2021
José Antonio Saavedra Arcas (Spain) - June 2020
Kalaivani Ramalingam (India) - September 2018
Jeslyn Wong (Singapore) – November 2016
Edna Cortes (Mexico) - August 2016
Nadia Bhal (United Kingdom) – July 2016
Roy Ng Kwok Weng (Singapore) – June 2016
Kai Lyn Ng (Singapore) – June 2016
Lucas Schreiner (Brazil) - April 2016
Farah Lone (United Kingdom) - March 2016
Suvit Bunyavejchevin (Thailand) - November 2014
Emmanuel Karantanis (Australia) - July 2014
Jacqueline Smalldridge (New Zealand) - May 2014
Roger Capmartin Salinas (Colombia) - September 2013
Louise Jane Tomlinson (New Zealand) - September 2013
Rachid Alfred El Haddad (Czech Republic) - September 2013
Natarajan Rajamaheswari (India) - June 2013

More information about courses offered by PROTECT-trained trainers can be found here.

Disclaimer:
PROTECT is sponsored by the International Urogynecological Association (IUGA) for educational purposes only. The material presented is not intended to represent the only or the best method appropriate for the medical conditions discussed, but rather is intended to present the opinions of the presenters, which may be of assistance to other healthcare professionals to arrive at their own conclusions and consequent application. Participants do so with full knowledge that they waive any claim they may have against the IUGA for reliance on information presented during these activities. The IUGA does not guarantee, warrant or endorse any commercial products or services.

Completion of the PROTECT program in no way implies that IUGA has endorsed, certified, qualified or licensed the individual, or the health care providers they teach or supervise. Whilst a Certificate of Completion for the PROTECT program can be provided as proof that training has been successfully completed, the certificate is not a qualification, as IUGA is not an accrediting body. Furthermore, nothing about this program or its examination is intended to replace, override, or conflict with licensing requirements for healthcare professionals.

Copyright: The IUGA and PROTECT name and logo 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. Courses using this signifier may only be offered following IUGA approval and may not be offered for profit.

Video Submission

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Step 4 of the Four-Step Process to become a PROTECT-trained trainer is the submission of personal videos. The videos must demonstrate your live surgical technique, including audio or text explanation of the points outlined below in the scoring criteria. Below you’ll find more information on submitting videos and the criteria for scoring them. 

 

Watch First: How to Prepare Your Submission

Before proceeding with Step 4, it is essential to watch the instructional videos. These offer vital guidance on how to correctly prepare and record your surgical submissions. Watching them in advance is crucial to ensure that your video meets the expected standards and aligns with the assessment criteria.

You can access the PROTECT Video tutorials in two ways:

  • Log in to the IUGA Members Only section and navigate to the IUGA Academy, where you can download the video tutorials listed under the category IUGA PROTECT PROGRAM, entitled
    1. PROTECT Program Video Tutorial: 4th Degree Tear Live - Overlap Technique
    2. PROTECT Program Video Tutorial: Repair of Mediolateral Episiotomy - Single Muscle Layer Closure

  • Alternatively, purchase a USB flash drive via Perineum.net (UKP 40) containing the video series Diagnosis and Repair of Acute Obstetric Perineal Trauma. This updated video series (13 videos) illustrates the anatomy of the perineum and anal sphincter and provides tips on the diagnosis of 3rd and 4th degree tears. Step by step repair of 3rd and 4th degree tears in the Sultan model, pig and postpartum woman is demonstrated. The repair of a mediolateral episiotomy is also included. Order the USB Flash drive via Perineum.net

Before submitting, watch an example video of a succesful submission on 4th Degree Tear Live - Overlap Technique
Log in to the IUGA Members Only section and navigate to the IUGA Academy, where you can download the video listed under the category IUGA PROTECT PROGRAM entitled 'Example Video on OASI by PROTECT-trainer Manisha Yadav, Nepal'


Submission of Videos 

  • Please submit your videos to the IUGA Office through the following link.
  • Please note that a consent form from the subject/patient in the videos must be submitted to the IUGA Office at This email address is being protected from spambots. You need JavaScript enabled to view it.. Please use the consent forms used by your own institution.


Criteria for Scoring Video Submissions 

  • Please ensure that each criterion is clearly demonstrated in order to pass.

EPISIOTOMY

OBSTETRIC ANAL SPHINCTER INJURY (3B,3C, 4 only)

Demonstration of proper rectal examination before repair to exclude OASIS or button-hole tear

Demonstration of a proper rectal examination technique before repair

Pill-rolling of the anal sphincter from 9-3 o’clock to confirm intact or tear

Demonstrating a pill-rolling examination

Identifying and demonstrating apex of vaginal laceration before suture insertion

Demonstrating classification of tear (3a,3b,3c,4)

Technique of repair with a continuous suture for all 3 layers

Identification of EAS** and demonstrating full length and thickness of tear

Ensuring and demonstrating location and repair of bulbospongiosus muscle

Demonstrating IAS* location and tear if present

Ensuring and demonstrating location and repair of superficial transverse perineal muscle

Performing a finger-lift test of the anal sphincter before repair

Suture material - Vicryl rapide 2-0 (explanation if not used)

Demonstrating the superficial transverse perineal muscles

Good apposition of muscle and skin

Demonstration of ischioanal fat (when necessary)

Demonstration of per rectal examination after repair

Suturing mucosa if 4th degree tear with continuous Vicryl 3-0

Quality of video for demonstration and teaching purposes

Repair of IAS* (end-to-end), preferably PDS 3-0

 

 Demonstrating full-length of EAS** tear before repair
  Repair of EAS** – End-to-end, preferably PDS 3-0 (Overlap only acceptable if full thickness 3b or greater)
 

Demonstration of per rectal examination after repair

 

Appropriate suture material (PDS 3-0 or Vicryl 2-0 for sphincters)

 

Quality of video for demonstration and teaching purposes


*IAS = Internal Anal Sphincter
**EAS = External Anal Sphincter

Photo Gallery

 protect.jpg

February 2025 - Goiânia - Brazil
Trainer Lucas Schreiner

Protect goiania2025 960                                                                                                                    

October 2024 - Porto Alegre - Brazil
Trainer Lucas Schreiner

Protect Portoalegre042024

June 2024 - Brasilia - Brazil
Trainer Lucas Schreiner

 Protect Brasilia2024

April 2024 - Porto Alegre - Brazil
Trainer Lucas Schreiner

 Protect Portoalegre042024

October 2023 - Porto Alegre - Brazil
Trainer Lucas Schreiner

 Protect PortoAlegre2023

September 2023 - Brasilia - Brazil
Trainer Lucas Schreiner

 Protect Brasilia2023

 

March 2021/Trainer: Kalaivani Ramalingam

KR1March-2021
KR3March-2021
KR2March-2021

February 2021/Trainer: Kalaivani Ramalingam

KRGuernsey3
KRGuernsey2
KRGuernsey4

October 2019/Trainer: Kalaivani Ramalingam

KR-Chennai-2019

August 2019/Trainer: Kalaivani Ramalingam

protect-august-2019-1
protect-august-2019-2
protect-august-2019-3

June 2019/Trainer: Kalaivani Ramalingam

protect-june2019-3
protect-june2019-2
protect-june2019-1

November 2018/Trainer: Roy Ng

Ng-1
Ng-2

November 2018/Trainer: Kalaivani Ramalingam

image1
image2
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August 2018/Trainer: Lucas Schreiner

proteclucas2018
IMG5903
inicial

June 2018/Trainer: Nadia Bhal

Physiotherapy-Talk
Kath-teaching-our-physiotherapy-team-the-principles-of-Manual-Perineal-Protection
Delegates-of-June-2018
Delegate-repairing-Pigs-Anal-Sphincter---4th-degree-tear
Delegates-and-hands-on-repair-with-Pigs-Anal-Sphincter

March 2018/Trainer: Roy Ng

2018-March-Ng-1
2018-March-Ng-2

Image

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