{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T16:02:43Z","timestamp":1785859363466,"version":"3.56.0"},"reference-count":31,"publisher":"BMJ","issue":"6","funder":[{"DOI":"10.13039\/501100005416","name":"Norges Forskningsr\u00e5d","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005416","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,5,24]]},"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore the impact of a training intervention on obstetric anal sphincter injuries\u2019 (OASIS) detection rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective quality improvement interventional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Six secondary and tertiary maternity units in Palestine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population<\/jats:title>\n                    <jats:p>Women having singleton vaginal births \u226523\u2009weeks\u2019 gestation or babies weighing \u2265500\u2009g (n=22 922). Caesarean births (n=5431), multiple gestations (n=443) and vaginal births of unregistered perineum status (n=800) were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Training programme for enhancing OASIS detection was conducted between 31 January and 31 December 2015. International experts delivered 2-day standardisation workshop teaching OASIS diagnosis and repair to each maternity unit. They also provided additional training to three research fellows employed in three of the maternity units. This was followed by 13-week period of data collection (phase 1). Research fellows then delivered training intervention over 15-week interval (phase 2), including theoretical teaching and \u2018onsite\u2019 training in perineal trauma assessment within the six maternity units. Finally, 13-week postintervention observation (phase 3) followed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measure<\/jats:title>\n                    <jats:p>OASIS rates were used as surrogate for OASIS recognition. OASIS rates were compared between different phases and between the two maternity unit groups (research fellow and non-research fellow based) using Pearson\u2019s \u03c7\u00b2 test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total 22 922 women were included. Among primiparous women, OASIS rate was higher in phase 2 (2.8%, p&lt;0.001) and phase 3 (3.1%, p&lt;0.001) than phase 1 (0.5%). However, no significant differences were detected in the rates of severe OASIS (third-degree 3c and fourth-degree tears) between phase 1 and 2 (0.5% vs 0.3%), because this would have required at least 103 women with severe OASIS to be included in each phase. Among parous women, OASIS rate was significantly higher in phase 2 (0.6%, p=0.002) but not in phase 3 (0.4%, p=0.071) compared with phase 1 (0.2%). Research fellows\u2019 maternity units showed higher OASIS rates among primiparous women in phase 2 (3.6% vs 1.4%, p=0.001) and phase 3 (4.3% vs 0.8%, p&lt;0.001) than non-research fellows\u2019 maternity units.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This work is basically an epidemiological study which has identified the prevalence of perineal lacerations and their severity on a large sample of women representative of an entire geographical ethnic region. The quality improvement intervention improved OASIS detection mainly in the research fellows\u2019 maternity units. Regular mandatory national programmes in obstetric perineal trauma assessment and management by local champions are essential to mitigate the risk of missing significant degrees of trauma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-020983","type":"journal-article","created":{"date-parts":[[2018,6,19]],"date-time":"2018-06-19T11:20:17Z","timestamp":1529407217000},"page":"e020983","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Enhancing recognition of obstetric anal sphincter injuries in six maternity units in Palestine: an interventional quality improvement study"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7075-2636","authenticated-orcid":false,"given":"Hadil","family":"Ali-Masri","sequence":"first","affiliation":[{"name":"The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway"},{"name":"Institute of Clinical Medicine, 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Rikshospitalet, Oslo, Norway"},{"name":"Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway"},{"name":"Department of Obstetrics, Al Aqsa Martyrs Hospital, Gaza, Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0177-4521","authenticated-orcid":false,"given":"Mohammed","family":"Zimmo","sequence":"additional","affiliation":[{"name":"The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway"},{"name":"Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway"},{"name":"Department of Obstetrics, Al Shifa Hospital, Gaza, Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Fosse","sequence":"additional","affiliation":[{"name":"The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway"},{"name":"Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c5se","family":"Vikanes","sequence":"additional","affiliation":[{"name":"The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katariina","family":"Laine","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Oslo University Hospital, Ullev\u00e5l, Oslo, Norway"},{"name":"Department of Health Management and Health Economics, Institute for Health and Society, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,6,19]]},"reference":[{"key":"2025121410271828000_8.6.e020983.1","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1016\/S1701-2163(16)30081-0","article-title":"Obstetrical anal sphincter injuries (OASIS): prevention, recognition, and 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