Background: Failure to identify and repair anal sphincter injuries sustained during childbirth can lead to significant long-term morbidity. This paper describes the evaluation methods used to assess the efficacy of The All Wales Hands-on Third and Fourth Degree Perineal Tear Repair Course in reducing the long-term complications associated with obstetric anal sphincter injuries (OASIS). Methods: Formative evaluation was received from the learners between 2015 and 2021. The post-surgical outcome after OASIS repair in North East Wales was assessed using a postal questionnaire sent to general practitioners between 2012 and 2015. The survey was done 1 year after the last case of OASIS in 2015. Results: Feedback from all the learner delegates suggested a high satisfaction rate. Forty-five women were identified as needing repair of OASIS giving an OASIS incidence of only 0.6%. Of the 45 questionnaires, 35 (77.8%) were returned by the general practitioners. None of the 35 women had reported any residual symptoms of anal incontinence to their general practitioner. Conclusion: This review demonstrates high post-course satisfaction rates among attending delegates and very low reported long-term complication rates after OASIS repair in women giving birth in North Wales. The simulation-based education described appears highly effective in reducing the long-term complications associated with obstetric anal sphincter injuries, suggesting that the skills developed in the laboratory are being transferred to the real-life setting. However, designing a strategy to adequately evaluate a course of this nature is difficult and needs careful planning to overcome the challenges posed by this type of research.

Postpartum haemorrhage accounts for 27% of all maternal deaths. Incorrect quantification of blood loss can lead to unnecessary interventions, such as the transfusion of blood products, which is not without risk. During pregnancy, cardiovascular changes may explain how blood loss can occur rapidly, with pregnant women tolerating large volumes of blood loss before a change in clinical signs is seen. Several methods are used to quantify blood loss, such as visual estimation, volumetric, gravimetric, colorimetric and photometric. The Obstetric Bleeding Strategy for Wales (OBS Cymru) project, which standardised management of obstetric haemorrhage in Wales using a four-stage approach, showed a statistically significant improvement in outcomes. Different definitions of postpartum haemorrhage make it difficult to compare available evidence. Further studies are required combining the use of point-of-care tests and quantitative techniques to help improve morbidity and mortality associated with obstetric haemorrhage. Learning objectivesTo understand the physiological changes in pregnancy and how they affect postpartum haemorrhage. To know the different available methods of quantifying blood loss. To review the point-of-care tests used to guide transfusion and management of postpartum haemorrhage. Ethical issuesUnderstanding the advantages and disadvantages of different methods of quantifying blood loss is essential to providing appropriate and safe care. Inaccuracy in measurement increases the risk of morbidity and mortality, in addition to complications of unnecessary treatments.