A prospective clinical audit evaluating the incision angle at mediolateral episiotomy for vaginal delivery

Abstract

Background: Increasingly, the angle at which the episiotomy is performed has come under scrutiny. The current recommendation is that because of distortion of the anatomy at crowning of the head, the incision should be at an angle of at least 60° from the midline to ensure that a post-delivery angle of 43° is achieved.Method: A prospective clinical audit was performed in Castle Street Hospital for Women, Colombo, Sri Lanka, evaluating the post-delivery angle after suturing of episiotomy in a sample of consecutive vaginally delivered women. The angle after repair was defined as the angle formed by the suture line and the midline is measured at the end of the suturing. OASI Care Bundle, recently developed by the RCOG was used as the gold standard reference.Results: A total of 105 consecutive vaginal deliveries with mediolateral episiotomy were evaluated. Mean age (SD) was 27.9 (6.0) years. Mean gestational age (SD) was 39.3 (1.7) and mean birthweight (SD) was 3.0 (0.5) kg. There were 97 (92.4%) spontaneous vaginal deliveries and 21 (20.0%) were diabetic. Majority, 48 (45.7%) had their first delivery. There were 6 (5.7%) third degree perineal tears and 24 (22.9%) had additional second degree perineal tears. Out of 105, 91 (86.7%) women had post-delivery angle of less than 45° and 33 (31.4%) of them were less than 30°. Only 14 (13.3%) episiotomies were having the correct post-delivery angle (45°). Majority (55.2%) had not been started from the midline. Conclusion:Current practice of incision angle at medio-lateral episiotomy is not satisfactory. Training using 'Episiotomy angle-cutter demonstrator' in the OASI Care Bundle has been planned before the re-audit.