Dataset Information

Perineal Laceration and Episiotomy Repair Using a Beef Tongue Model.

ABSTRACT:

Introduction

Declining rates of operative vaginal deliveries and routine episiotomy in obstetric practice, along with rising cesarean section rates, have decreased OB/GYN resident experience with episiotomy repair and obstetric anal sphincter injuries (OASIS). Simulation models are valuable educational tools in procedural training. Several models have been reported, each with its own limitations and benefits.

Methods

We developed a 1-hour workshop to teach novice OB/GYN residents perineal laceration repair skills on a modified beef tongue model. The model required 5-10 minutes to assemble following written and video instruction, and learners had 30-50 minutes to practice using learner instructions. Learners were evaluated using a procedure checklist and global objective structured assessment of technical skills. To evaluate the session, we surveyed current faculty and residents, as well as residency graduates.

Results

Between 2008 and 2017, an estimated 82 OB/GYN residents participated in this activity, and 95 participants and facilitators received the survey. Forty-one (59%) respondents agreed that this model was similar to repairing OASIS in clinical practice. Our trainees reported that the optimal time for simulated OASIS repair was the R2 and R3 years; however, 90% of respondents felt residents should be offered this simulation yearly.

Discussion

Based on our survey of trainees, graduates, and faculty, we created a realistic simulated OASIS repair training, despite the limitation that the model lacked a rectum. Learners reported an interest in repeating the simulation frequently during residency to augment their clinical experience and increase perceived competence in third- and fourth-degree laceration repair by their graduation.

SUBMITTER: Eston M

PROVIDER: S-EPMC7062543 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Publications

Perineal Laceration and Episiotomy Repair Using a Beef Tongue Model.

Eston Michelle M Stephenson-Famy Alyssa A McKenna Hannah H Fialkow Michael M

MedEdPORTAL : the journal of teaching and learning resources 20200214

<h4>Introduction</h4>Declining rates of operative vaginal deliveries and routine episiotomy in obstetric practice, along with rising cesarean section rates, have decreased OB/GYN resident experience with episiotomy repair and obstetric anal sphincter injuries (OASIS). Simulation models are valuable educational tools in procedural training. Several models have been reported, each with its own limitations and benefits.<h4>Methods</h4>We developed a 1-hour workshop to teach novice OB/GYN residents ...[more]

PMID: 32175472

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Project description:IntroductionPerineal lacerations during childbirth are common, and suturing the perineal skin during repair has been associated with increased postpartum pain. This study sought to test the hypothesis that no difference in postpartum perineal pain exists between 3 methods of skin closure for second-degree repair: suture, no suture, and surgical glue.MethodsA single-blind randomized controlled trial of women after vaginal birth who had a second-degree perineal laceration was conducted at a tertiary care teaching hospital from August 2014 to April 2017. Women were randomized to perineal skin closure with suture, no suture, or surgical glue using a 1:1:1 allocation. Pain was assessed using the short-form McGill Pain Questionnaire, a 100-mm visual analog scale (VAS), and Present Pain Index (PPI) at one day, 2 weeks, 6 weeks, and 3 months postpartum. Wound healing was assessed at 6 weeks using the Redness, Edema, Ecchymosis, Drainage, Approximation (REEDA) scale. Pain scores were compared across groups using a chi-square test, Mann-Whitney U test, or analysis of variance where appropriate.ResultsA total of 35 women were randomized: 14 received suture, 11 had no suture, and 10 received surgical glue for perineal skin repair. Demographic characteristics were similar between groups. At 2 weeks postpartum, women with suture had higher median pain scores on the short-form McGill Pain Questionnaire (15.0 suture vs 2.0 glue vs 2.0 no suture, P = .03) and VAS (50.0 suture vs 3.0 glue vs 7.0 no suture, P = .02). Significant differences in pain were not seen on the PPI. At 3 months, women in the suture group had higher median pain scores on the short-form McGill Pain Questionnaire compared with surgical glue (1.0 vs 0, P = .04). Wound healing was similar across groups (REEDA score: 0 suture vs 1.0 no suture, vs 0 surgical glue, P = .24).DiscussionCompared with no suture and surgical glue, suturing the perineal skin was associated with the highest postpartum pain scores.

Project description:BACKGROUND:Perineal pain due to episiotomy is commonly reported and can be severe enough to disturb the mother-infant dyad during the postpartum period. Its incidence at day 7 postpartum varies from 63% to 74%. Recent studies have investigated the analgesic efficacy of perineal infiltration of ropivacaine after episiotomy but have only focused on the immediate postpartum period (at 24 and 48?h after birth). Large, adequately powered, multicenter, randomized controlled trials are required to evaluate the impact of ropivacaine infiltration on perineal pain and mid- and long-term quality of life before the widespread use of ropivacaine to prevent perineal pain after episiotomy can be recommended. METHODS/DESIGN:The ROPISIO study is a two-center, randomized, double-blind, placebo-controlled trial being conducted in La Roche sur Yon and Nantes, France. It will involve 272 women with vaginal singleton delivery and mediolateral episiotomy at term (??37?weeks). Perineal infiltration (ropivacaine 75?mg or placebo) will be administrated just after vaginal birth and before episiotomy repair. The primary outcome will be the analgesic efficacy at day 7 postpartum (midterm), defined by the Numeric Pain Rating Scale (NPRS) strictly superior to 3/10 on the perineal repair area. Secondary outcomes will be the analgesic efficacy (NPRS) and the impact of pain on daily behavior, on the quality of life (36-item Short Form Health Survey), on the occurrence of symptoms of postpartum depression (Edinburgh Postnatal Depression Scale), and on sexual health (Female Sexual Function Index) at 3 and 6?months (long-term) using validated online questionnaires. This study will have 90% power to show approximately 30% relative risk reduction in the incidence of perineal pain at day 7, from 70.0% to 50.0%. DISCUSSION:Ropivacaine is a promising candidate drug, inexpensive, and easy to administer, and it would be suitable to include in the routine management of deliveries in labor ward. This study will investigate if perineal ropivacaine infiltration just after birth can reduce mid- and long-term postpartum pain and increase quality of life in women with mediolateral episiotomy. TRIAL REGISTRATION:ClinicalTrials.gov, NCT03084549. Registered on 14 April 2017.

Project description:BackgroundLacrimal canalicular laceration can be caused by trauma on the ocular adnexa, such as penetrating or blunt injuries, accounting for approximately 16% of eyelid lacerations and 20% of eye traumas. Historically, canalicular anastomosis combined with bi-canalicular or mono-canalicular stent intubation has been used for canalicular laceration repair. In this study, we analyzed the epidemiological characteristics of lacrimal canalicular laceration and evaluate the clinical outcomes of repair using the bi-canalicular stent in central China. It aims to provide a reference for clinical work.MethodsThis is a review of 338 patients (338 eyes) with eyelid lacrimal canaliculus laceration undergoing reparative bi-canalicular stent intubation from January 1st 2017 to December 30th 2020. The analyzed data included demographics, the place of occurrence of the trauma, the mechanism of injury, additional injury, and surgical outcomes at follow-up. The outcomes included anatomic success, functional success, and complications.ResultsThe average age was 39.6±20.0 years (1 to 88 years). Of all the 338 patients, 254 (75.15%) patients were men. Upper and lower canalicular lacerations were seen in 68 (20.12%) and 256 (75.74%) patients, respectively. Also, 14 patients (4.14%) presented with both upper and lower canalicular lacerations. Most injuries occurred on the streets (146, 43.20%), followed by the home in 111 (32.84%) patients. Traffic accidents were the leading cause of injury (127, 37.57%), including 72 (21.30%) cases of electric bike-associated accidents, followed by fall-related trauma in 65 (19.23%) cases. During the follow-up, there were 6 (1.78%) patients with eyelid ectropion and 9 (2.66%) patients with stent extrusion and loss due to eye rubbing and pulling the sutures out. At the end of follow-up, the anatomical success rate was 95.86% and the functional success rate was 89.64%.ConclusionsElectric bike-associated accidents occurring on the streets is the current leading cause of injury in central China. Lacrimal canalicular laceration repair with a bi-canalicular stent offers an effective surgical therapeutic strategy for traumatic canalicular lacerations. In addition, avoiding traffic accidents is also one way prevent lacrimal canalicular laceration.

Dataset Information

Perineal Laceration and Episiotomy Repair Using a Beef Tongue Model.

Introduction

Methods

Results

Discussion

Publications

Perineal Laceration and Episiotomy Repair Using a Beef Tongue Model.

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