Comparison of obstetric anal sphincter injuries in nulliparous women before and after introduction of the EPISCISSORS-60® at two hospitals in the United Kingdom

Abstract

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.

The impact of third- or fourth-degree perineal tears on the second pregnancy: A cohort study of 182,445 Scottish women

“…Robust research such as a randomised controlled trial to determine whether or not a prophylactic episiotomy is effective at preventing third- or fourth-degree tears in a second vaginal birth for women with an initial injury is needed. Furthermore, angled and specially designed episiotomy scissors[42] need to be assessed in a randomised controlled trial to determine their effectiveness at reducing the risk of both initial and repeat third and fourth degree tears. There was no association found with episiotomy use in second births which resulted in repeat third- or fourth-degree tears in this study, however these results need to be interpreted with caution as there is a risk of a type two error.…”

Increased Oasis Incidence – Indicator of the Quality of Obstetric Care?

“…Lavesson’s special perineal device and Epi-No birth trainer failed to reduce the rates of episiotomy and perineal tears ( 49 - 51 ). Special perineum designed scissors are being developed ( 52 ). In order to have the best effect in the prevention of perineal injuries, various types of gels are being invented and introduced to medical practice for their suitability and safety in use ( 53 ).…”

Use of 2D and multislice transperineal ultrasonography to describe the degree of perineal laceration following vaginal delivery

“…Women detected with anal sphincter defect was subjected to a standard repair methodology, which included identification and repair of internal anal sphincter (IAS) by using PGA 3.0 suture in horizontal mattress manner and repair of external anal sphincter (EAS) by using PGA 2.0 suture in an end-to-end or overlapping manner depending on the degree of perineal laceration. [10][11][12] All patients underwent 2D/multislice TPUS 72 hours after delivery, and the sonographer was unaware of the patient's mode of delivery and the degree of perineal laceration. All 2D/multislice TPUS volume sets were acquired using GE Voluson E8 expert BT09 (GE Medical System, Zipf, Austria) with 4-9 MHz convex volume probe RIC5-9-D.…”