OASIS recognition and repair — procedural station

Procedural station on obstetric anal sphincter injury: systematic genital tract assessment with rectal examination, correct grading under uncertainty, the decision to move to theatre, layer-by-layer repair with named suture materials, and the postoperative package. Includes assessor timeline, marking domains, assessor key and fail criteria.

Prompt

A 29-year-old primigravida has just had a ventouse birth for a prolonged second stage; birthweight 3980 g, occipitoposterior at the start of the second stage, no episiotomy was cut. The midwife has prepared a suture trolley in the birth room and tells you it looks like 'a big second-degree'. You are the registrar. A consultant is available by phone and can attend within 20 minutes. The assessor will run the clock, feed you findings, and expect you to verbalise every step of assessment, grading and repair.

Station brief

Format. Procedural station, approximately 12 minutes. You are the obstetric registrar in the birth room. A midwife is with you and has prepared a suture trolley. The consultant is contactable and 20 minutes away. The assessor will feed you examination findings as you request them. ^[1]

Candidate instruction. Assess the genital tract, classify any injury you find, decide where and how it should be repaired, and describe the repair and the postoperative plan. Verbalise everything, including what you say to the woman. ^[1]

References6Show

[1]Committee on Practice Bulletins-Obstetrics ACOG Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery Obstet Gynecol, 2018.PMID 30134424
[2]Fernando RJ, Sultan AH, Kettle C, et al. Methods of repair for obstetric anal sphincter injury Cochrane Database Syst Rev, 2013.PMID 24318732
[3]Kettle C, Dowswell T, Ismail KM Continuous and interrupted suturing techniques for repair of episiotomy or second-degree tears Cochrane Database Syst Rev, 2012.PMID 23152204
[4]Roper JC, Thakar R, Sultan AH Isolated rectal buttonhole tears in obstetrics: case series and review of the literature Int Urogynecol J, 2021.PMID 32930849
[5]Eogan M, Daly L, Behan M, et al. Randomised clinical trial of a laxative alone versus a laxative and a bulking agent after primary repair of obstetric anal sphincter injury BJOG, 2007.PMID 17516966
[6]Okeahialam NA, Wong KW, Thakar R, et al. The incidence of wound complications following primary repair of obstetric anal sphincter injury: a systematic review and meta-analysis Am J Obstet Gynecol, 2022.PMID 35550375

OASIS recognition and repair — procedural station

Station brief

References6Show

[1]Committee on Practice Bulletins-Obstetrics ACOG Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery Obstet Gynecol, 2018.PMID 30134424
[2]Fernando RJ, Sultan AH, Kettle C, et al. Methods of repair for obstetric anal sphincter injury Cochrane Database Syst Rev, 2013.PMID 24318732
[3]Kettle C, Dowswell T, Ismail KM Continuous and interrupted suturing techniques for repair of episiotomy or second-degree tears Cochrane Database Syst Rev, 2012.PMID 23152204
[4]Roper JC, Thakar R, Sultan AH Isolated rectal buttonhole tears in obstetrics: case series and review of the literature Int Urogynecol J, 2021.PMID 32930849
[5]Eogan M, Daly L, Behan M, et al. Randomised clinical trial of a laxative alone versus a laxative and a bulking agent after primary repair of obstetric anal sphincter injury BJOG, 2007.PMID 17516966
[6]Okeahialam NA, Wong KW, Thakar R, et al. The incidence of wound complications following primary repair of obstetric anal sphincter injury: a systematic review and meta-analysis Am J Obstet Gynecol, 2022.PMID 35550375