AimTo assess whether the introduction of episiotomy scissors specially designed to achieve a cutting angle of 60°, EPISCISSORS-60®, in two hospitals in the UK would result in a reduction in obstetric anal sphincter injuries (OASIS) in nulliparous women.MethodsA structured training program for all doctors and midwives provided a theoretical framework around OASIS including risk factors and the role of episiotomies and a practical hands-on training element to use EPISCISSORS-60® correctly and to measure perineal body length and post-suturing angles. Data for perineal body length, post-suturing angles, user feedback, episiotomy use, and incidence of OASIS were collected through specifically designed forms and the general hospital data collection system.ResultsData were available for 838 nulliparous vaginal deliveries. Mean perineal body length was 37 mm in spontaneous vaginal delivery group (standard deviation [SD] =8.3, 95% confidence interval [CI] =34–39) and 38 mm in the operative vaginal delivery group (SD=8, 95% CI=35–40). Post-suturing episiotomy angles were 53° (SD=6.5, 95% CI=50.7–55.8) in spontaneous vaginal deliveries and 52° (SD=9.6, 95% CI=49–54) in operative vaginal deliveries. EPISCISSORS-60® were rated as “good” to “very good” by 84% of users. There was a 47% increase in the number of episiotomies in nulliparous spontaneous vaginal deliveries at Poole (P=0.007) and a 16.5% increase in the number of episiotomies in nulliparous operative vaginal deliveries in Hinchingbrooke (P=0.003). There was an overall 11% increase in episiotomy numbers in nulliparous vaginal deliveries (P=0.08). There was a statistically significant OASIS reduction of 84% in nulliparous spontaneous vaginal deliveries in women who received an episiotomy (P=0.003).ConclusionInitial results after introduction of EPISCISSORS-60® show that the majority of health care professionals achieve post-suturing episiotomy angles between 40° and 60°. The results also show a significant increase in the use of episiotomies in the delivery of nulliparous women. There has been a statistically significant reduction in OASIS in nulliparous spontaneous vaginal deliveries.
Objectives: To assess the performance of maternal characteristics, ultrasound fetal biometry and Doppler evaluation at routine third trimester scan in low risk pregnancies with apparently normal fetal growth for the prediction of late smallness-for-gestational age fetuses. Methods: A cohort of 1004 fetuses was created of consecutive singleton pregnancies attended for routine third trimester scan (34 ± 2 weeks). Inclusion criteria were: (i) an estimated fetal weight >10th centile and (ii) a umbilical artery Doppler pulsatility index (PI) below the 95th centile. At inclusion, umbilical artery (UA), middle cerebral artery (MCA) and mean uterine artery (UtA) pulsatility indices (PI) and umbilical vein blood flow (BF) (mL/min) was calculated. SGA was defined as birthweight below the 10th centile according to local standards. The association between ultrasound and fetal Doppler parameters and the subsequent development of SGA was analysed by binomial logistic regression. Furthermore, a predictive model for SGA was constructed with a decision tree analysis using an exhaustive chi-squared automatic interaction detector (CHAID). Results: A total of 114 (11.4%) babies qualified for SGA. Multivariable analysis showed that significant contributions to prediction of SGA were provided by nulliparity (p = 0.006), EFW percentile (p = 0.024), UtA-PI (p = 0.001) and UV blood flow normalised by fetal weight (p = 0.048). Decision tree analysis defined two groups with differing risk of SGA: UtA-PI < 0.77 (risk 9.7%) or EFW centile > 30% (risk 10.3%); and, UtA-PI ≥ 0.77 and EFW centile ≤ 30% (risk 47.6%). Conclusions: Estimated fetal weight and uterine Doppler assessment may be of value in detecting at third trimester routine scan adequate for gestational age pregnancies that are at risk of late pregnancy small-for-gestational age fetuses (SGA). These findings may be of particular value in predicting adverse perinatal outcome associated to SGA, not detected before delivery. Barcelona, Spain; 2 Fetal Maternal Medicine, Hospital Clinic, Barcelona, Spain; 3 Hospital Clinic, Barcelona, Spain; 4 Hospital Clinic, Universitat de Barcelona, Barcelona, Spain; 5 Maternal Fetal Medicine Department, ICGON, Hospital Clinic Universitat de Barcelona; Fetal and Perinatal Medicine Research Group, IDIBAPS, CIBERER, Barcelona, Spain; 6 Maternal Fetal Medicine, Barranquilla, Colombia Objectives: To assess the performance of maternal characteristics, ultrasound fetal biometry and Doppler evaluation at routine third trimester scan in low risk pregnancies with apparently normal fetal growth for the prediction of large-for-gestational age fetuses (LGA). Methods: A cohort of 1004 fetuses was created of consecutive singleton pregnancies attended for routine third trimester scan (34 ± 2 weeks). Inclusion criteria were: (i) an estimated fetal weight > 10th centile and (ii) a umbilical artery Doppler pulsatility index (PI) below the 95th centile. At inclusion, umbilical artery (UA), middle cerebral artery (MCA) and mean uterine artery (UtA) pulsatil...
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