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Title: Diagnosis and repair of perineal injuries: knowledge before and after expert training—a multicentre observational study among Palestinian physicians and midwives
Authors: Zimmo, Kaled 
Laine, Katariina 
Vikanes, Åse 
Fosse, Erik 
Zimmo, Mohammed 
Ali, Hadil 
Thakar, Ranee 
Sultan, Abdul H. 
Hassan, Sahar 
Keywords: Perineal injuries - Diagmosis;Perineal injuries - Treatment;Obstetrics - Training - Palestine;Midwifery - Training - Palestine
Issue Date: 2017
Abstract: Objective: To assess whether a 2 day straining with experts teaching on diagnosis and repair of perineal injuries among Palestinian midwives sand physicians could change the ir level of knowledge towards the correct diagnosis and treatment. Study design : Multicenter observational study. Setting: Obstetric departments in 6 government Palestinian hospitals. Participants: All physicians and midwives who attended the training. Methods: A question nairecomprising 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 Mc Nemar test. Results: 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 can alsphinctertears improved from 28.5% to 42.8%(p=0.05), whereas knowledge of repairing torn internal anal sphincter separately improved from12.8% to 86.8% (p<0.001).
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