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The development and validation of an internet-based training package for the management of perineal trauma following childbirth: MaternityPEARLS
  1. Ayesha Mahmud1,
  2. Christine Kettle2,3,
  3. Debra Bick4,
  4. Claire Rowley2,
  5. Trishna Rathod5,
  6. John Belcher5,
  7. Mohamed M Abdelmaguid6,
  8. Khaled M K Ismail1,7
  1. 1Department of Obstetrics and Gynaecology, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
  2. 2The Maternity Centre, University Hospital of North Staffordshire NHS Trust, Stoke on Trent, Staffordshire, UK
  3. 3School of Nursing & Midwifery, Faculty of Health Sciences, Staffordshire University, Stafford, UK
  4. 4King's College London, Florence Nightingale School of Nursing and Midwifery, London, UK
  5. 5Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK
  6. 6School of Science, Technology and Health, University Campus Suffolk, James Hehir Building, Ipswich, UK
  7. 7School of Clinical & Experimental Medicine, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
  1. Correspondence to Professor Khaled M K Ismail, Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, Edgbaston, Birmingham B15 2TG, UK; k.ismail{at}


Background Birth-related perineal trauma has a major impact on women's health. Appropriate management of perineal injuries requires clinical knowledge and skill. At present, there is no agreement as to what constitutes an effective clinical training programme, despite the presence of sufficient evidence to support standardised perineal repair techniques. To address this deficiency, we developed and validated an interactive distance learning multi-professional training package called MaternityPEARLS.

Method MaternityPEARLS was developed as a comprehensive e-learning package in 2010. The main aim of the MaternityPEARLS project was to develop, refine and validate this multi-professional e-learning tool. The effect of MaternityPEARLS in improving clinical skills and knowledge was compared with two other training models; traditional training (lectures + model-based hands on training) and offline computer lab-based training. Midwives and obstetricians were recruited for each training modality from three maternity units. An analysis of covariance was done to assess the effects of clinical profession and years of experience on scoring within each group. Feedback on MaternityPEARLS was also collected from participants. The project started in January 2010 and was completed in December 2010.

Results Thirty-eight participants were included in the study. Pretraining and post-training scores in each group showed considerable improvement in skill scores (p<0.001 in all groups). Mean changes were similar across all three groups for knowledge (3.24 (SD 5.38), 3.00 (SD 3.74), 3.30 (SD 3.73)) and skill (25.34 (SD 8.96), 22.82 (SD 9.24), 20.7 (SD 9.76)) in the traditional, offline computer lab-based and e-learning groups, respectively. There was no evidence of any effect of clinical experience and baseline knowledge on outcomes.

Conclusions MaternityPEARLS is the first validated perineal trauma management e-learning package. It provides a level of improvement in skill and knowledge comparable to traditional methods of training. However, as an e-learning system, it has the advantage of ensuring the delivery of a standardised, continuously updated curriculum that has global accessibility.

  • birth
  • Obstetric
  • e-learning
  • Maternity
  • Midwifery
  • perineum

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