Comparison of Obstetric anal sphincter injuries (OASIS) in nulliparous women before and after introduction of the EPISCISSORS-60® at two Hospitals in the United Kingdom

Roon, Yves van; Kirwin, C. B.; Rahman, Nor Azlina A; Vinayakarao, Latha; Melson, Louise; Kester, Nikki; Pathak, Sangeeta; Pradhan, Ashish

doi:10.1055/s-0036-1583793

Cited by 4 publications

(3 citation statements)

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“…In view of that, the cutting instrument Episcissor-60 (Medivent Limited, Romsey, Hampshire, SO51 8BW, UK) was devised to help clinicians cut episiotomy at a fixed angle of 60°. When used, the Episcissor-60 has consistently achieved the recommended episiotomy angle which is supposed to reduce OASIS risk [ 26 ]. Nevertheless, the Episcissor-60 is relatively expensive and unaffordable by resource-constrained settings.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Accuracy of Episiotomy Incision in a Governmental Maternity Unit in Palestine: An Observational Study

Ali-Masri

Hassan

Zimmo

et al. 2018

Obstetrics and Gynecology International

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Episiotomy should be cut at certain internationally set criteria to minimize risk of obstetric anal sphincter injuries (OASIS) and anal incontinence. The aim of this study was to assess the accuracy of cutting right mediolateral episiotomy (RMLE). An institution-based prospective cohort study was undertaken in a Palestinian maternity unit from February 1, to December 31, 2016. Women having vaginal birth at gestational weeks ≥24 or birthweight ≥1000 g and with intended RMLE were eligible (n=240). Transparent plastic films were used to trace sutured episiotomy in relation to the midline within 24-hour postpartum. These were used to measure incisions' distance from midline, and suture angles were used to classify the incisions into RMLE, lateral, and midline episiotomy groups. Clinical characteristics and association with OASIS were compared between episiotomy groups. A subanalysis by profession (midwife or trainee doctor) was done. Less than 30% were RMLE of which 59% had a suture angle of <40° (equivalent to an incision angle of <60°). There was a trend of higher OASIS rate, but not statistically significant, in the midline (16%, OR: 1.7, CI: 0.61–4.5) and unclassified groups (16.5%, OR: 1.8, CI: 0.8–4.3) than RMLE and lateral groups (10%). No significant differences were observed between episiotomies cut by doctors and midwives. Most of the assessed episiotomies lacked the agreed criteria for RMLE and had less than optimal incision angle which increases risk of severe complications. A well-structured training program on how to cut episiotomy is recommended.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Accuracy of Episiotomy Incision in a Governmental Maternity Unit in Palestine: An Observational Study

Ali-Masri

Hassan

Zimmo

et al. 2018

Obstetrics and Gynecology International

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“…The risk of getting OASI can be done by relieving pressure on the central posterior perineum by an episiotomy and/or controlled delivery of the head. An episiotomy aimed at 60° from the midline has been seen to be protective for OASI [36]; hence, the introduction of episiotomy scissors specially designed to achieve a cutting angle of 60°, EPISCISSORS-60® [37]. Vacuum-assisted delivery and bigger babies were seen to be an important independent factor in one cohort study [38].…”

Section: Obstetric Anal Sphincter Injuries (Oasi)mentioning

confidence: 99%

Update and Trend in Episiotomy Practice

Pebalo¹,

Ayikoru²

2023

Current Challenges in Childbirth

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Episiotomy is one of the most commonly practiced obstetric procedures done to enlarge the diameter of the vulval outlet to facilitate the passage for the fetal head and prevent an uncontrolled tear of the perineal tissues in the second stage of labor. Historically, the procedure was indicated to prevent third- or fourth-degree perineal tears as well as for prolonged second stage, macrosomia, non-reassuring fetal heart rate, instrumental delivery, occiput posterior position, and shoulder dystocia. Routine episiotomy is now considered to be obstetrics violence, rates of not exceeding 10% have been recommended by World Health Organization (WHO). Despite this recommendation, episiotomy is still practiced routinely in many settings.

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“…The 18% OASIS reduction demonstrated in a recently published two centre UK study using 60° angled episiotomy scissors is a case in point. 14 Whether it is compelling enough to invite allegations of disregard for patient safety remains to be tested.…”

Section: Causationmentioning

confidence: 99%