Training for resident doctors and nurses has a positive and direct influence on care practice in health services (1,3). Therefore, the level of training is an indicator of the quality of these services. The aim of this study is to analyse the impact of teaching and/or training on the percentage of episiotomies performed, the percentage of tears diagnosed and the proportion of intact perineums after a course for residents and midwifes in trainning.

Since 2014, an annual workshop on the indication, performance and repair of episiotomies has been held as part of a course on perineum injuries for Gynaecology and Obstetrics residents and midwives. 

This retrospective study was conducted to determine the effect of the course on the diagnosis and repair of perineal lesions (PL). We collected data on perineal injury diagnosed in the years 2011 to 2013 pre-course and data on perineum lesions in the years 2015 to 2017 post-course. We took into account the parity of the pregnant women, whether or not episiotomy was performed, whether tears occurred and the degree of tearing. The percentage of episiotomies, perineal injuries (considering episiotomies as second-degree tears) and the percentage of OASIs (Obstetrics Anal Sphynter Injuries) pre and post-course were analysed.

A total of 6005 cases were collected, 2989 pre-course and 3015 post-course. The percentage of episiotomies decreased from 48.7% pre-course to 37.4% post-course, statistically significantly (p<0.005). Overall, the percentage of cases with an intact perineum increased from 20.8% pre-course to 24.0% post-course (p<0.005). However, the percentage of OASIs increased from 0.5% pre-course to 0.9% post-course, bordering on significant (p=0.05).

Since the annual workshop on Perineum Injuries diagnosis and repair has been held, a decrease in the percentage of both episiotomies and PI has been observed in our centre. The increase in the proportion of OASIs deserves further and longer-term study to determine whether this is secondary to better diagnosis of OASIs following the training received (1) or whether it is a negative effect of the decrease in the number of episiotomies.

Training courses for doctors and nurse residents in training have proven to be an efficient and effective tool for improving diagnosis, treatment and, above all, injury prevention in patients (1, 2). Therefore, these courses should be conducted more often and the impact of these courses on patients' health should continue to be re-evaluated. (3)

Further studies are necessary to determine if those patients in whom episiotomy was not performed were the same as those diagnosed with OASIs and if the application of a risk calculator for OASIs would have been useful in these patients.

Diagnosis, management and training in perineal trauma: a UK national survey of obstetricians. Roper,J; Thakar, R;  Hurt,J  et al. Int Urogynecol J. 2023; 34(12): 2873–2883.
Effectiveness of structured education and training in perineal wound assessment and repair for midwives and midwifery students: A review of the literature. Monica P. Diaz, Naomi Simpson, Angela Brown, Faith C. Diorgu. Eur J Midwifery. 2021; 5: 13.
Does the Epi-No(®) birth trainer prevent vaginal birth-related pelvic floor trauma? A multicentre prospective randomised controlled trial. Kamisan Atan , K L Shek, S Langer, R Guzman Rojas, J Caudwell-Hall, J O Daly , H P Dietz.   BJOG . 2016 May;123(6):995-1003. Epub 2016 Feb 29.