Defence: Kaled Zimmo

MD Kaled Mikki Yousef Zimmo at Institute of Clinical Medicine will be defending the thesis "Episiotomy practice in Palestine. Rates, indications and impact of an educational program in six hospitals" for the degree of PhD.

Foto: Øystein Horgmo

Trial Lecture - time and place

See Trial Lecture.

Adjudication committee

  • 1st opponent: Professor James Dornan, Ulster University
  • 2nd opponent: Head of Department Astrid Rygh, Helse Stavanger HF
  • Comittee Chair: Adjunct Professor Marie Ellström Engh, University of Oslo

Chair of the Defence

Professor Emeritus Kjetil Klaveness Melby

Principal Supervisor

Dr. Sahar Hassan


Episiotomy is an incision of the perineal muscles to enlarge the outlet at childbirth. It is the commonest surgical procedure at childbirth, but may cause perineal problems and should therefore not be done routinely at all deliveries. This thesis assessed Palestinian birth attendants' knowledge of diagnosis and management of perineal injuries before and after expert training, and explored current episiotomy practice in Palestine. Moreover, the effectiveness of two educational interventions, employing bimanual perineal support technique, to reduce episiotomy rates were tested. 

Data were collected by questionnaire among midwives and gynecologists in six government  hospitals located in Gaza and the West Bank from January to May 2015, further were obtained from ‘’ The Palestinian Perineum and Birth Complication Study ‘’, which registered over 75 000 birth events from March 1st 2015 to April 30th 2017.

Variable improvements in the knowledge before and after the training were observed among physicians and midwives in areas including perineal anatomy, the need for rectal examination before and after suturing episiotomies, best practice of skin repair as well as external anal sphincter tears. The overall episiotomy rate was 28.7%; with 78.8% for women with their first vaginal birth and 5.9% for parous women. The most common indication for episiotomy was “primiparity” in the first vaginal birth group (69.9%), and “protecting the perineum” in parous women (59.5%). Episiotomy rates decreased significantly from 61.1% to 38.1% in the two hospitals that received both interventions (animation and hands-on-training in bimanual perineal support technique).

In Palestine, episiotomy is done routinely in women with their first vaginal birth. This thesis demonstrates the effectiveness of training to optimize episiotomy performance and enhance practice in diagnosis and repair of perineal injuries as well as to reduce episiotomy rates and thus improve postpartum perineal Health.

Additional information

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Published Nov. 26, 2018 3:53 PM - Last modified Nov. 27, 2018 3:48 PM