Defence: Hadil Yousif Ali

MD Hadil Yousif Ali at Institute of Clinical Medicine will be defending the thesis "Palestinian Perineum Study. Obstetric Anal Sphincter Injuries in Palestine: education and training in detection and prevention" for the degree of PhD.

Foto: Øystein Horgmo

Trial Lecture - time and place

See Trial Lecture.

Adjudication committee

  • 1st opponent: Senior Consultant Dr. Helga Margrethe Elisabeth Gimbel, University of Southern Denmark
  • 2nd opponent: Professor Torbjørn Moe Eggebø, NTNU
  • Committee Chair: Professor Henrik Holmstrøm, University of Oslo

Chair of the Defence

 Professor Anne Cathrine Staff

Principal Supervisor

Associate Professor Katariina Laine


Obstetric anal sphincter injuries (OASIS) are severe vaginal birth complications that involve disruption of the anorectal complex. Women sustaining OASIS are more prone to perineal pain, sexual dysfunction, anal incontinence and psychosocial problems. Detection and repair of OASIS require adequate training. Mediolateral episiotomy at 60° angle from midline and manual perineal support during childbirth prevent OASIS. In Palestine, there have been no previous reports on OASIS.

The aims of this thesis were to improve OASIS detection in six Palestinian hospitals by training birth attendants in systematic assessment of perineal injuries through bedside and simulation training and to reduce OASIS risk by training birth attendants in accurate episiotomy technique and manual perineal support, using animated electronic and blended training methods.

Variations in OASIS incidence were measured and data were collected by case registration forms and postpartum clinical examinations. Attitudes of multinational doctors and midwives to the animated electronic training method was assessed by online questionnaire before testing it in the clinical setting. A sample of intended mediolateral episiotomy incisions was examined to assess the quality of the technique.

After training in assessment of perineal injuries, OASIS detection increased by about 83% among primiparous and 60% among parous women.

Less than 30% of the examined episiotomy incisions met the mediolateral technique criteria and only 12% were mediolateral with adequate angle.

The animated electronic method was evaluated as a feasible learning tool and when tested on clinical grounds it resulted in 45% reduction in OASIS incidence. However, the blended training method was almost twice as effective resulting in 74% reduction in OASIS incidence.

Different educational and training modalities for the diagnosis and prevention of OASIS has improved the quality of obstetric care and consequently reduced maternal morbidity.

Additional information

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Published Nov. 27, 2018 12:49 PM - Last modified Nov. 28, 2018 12:27 PM