Abstract
Introduction and hypothesis
We compared the clinician’s ability to cut episiotomies at the recommended 60° angle with traditional straight Mayo scissors compared with patented fixed-angle episiotomy scissors EPISCISSORS-60® in a simulated setting using mounted incision pads. The hypothesis was that fixed-angle episiotomies would achieve a more accurate cutting angle of 60°.
Methods
Angles were cut on episiotomy incision pads in a mounted birth model simulating crowning: 110 midwives and doctors cut an 60° episiotomy with Mayo scissors and then EPISCISSORS-60. Angles were measured with protractors. Average angles were calculated and the one-tailed paired t test was used to compare groups.
Results
Mean angle was 45° with Mayo scissors [SD = 9, 95% confidence interval (CI) = 43.3–46.7, interquartile range (IQR) 38–50] and 60° with the EPISCISSORS-60 (SD = 3, 95% CI = 59.3–60.7, IQR = 58–60). Two-thirds of cuts with Mayo scissors were below 50°.
Conclusions
In a simulated setting the majority of operators are unable to cut an episiotomy at the recommended 60° angle with Mayo scissors. The EPISCISSORS-60 cut an episiotomy a statistically significant 15° wider than regular Mayo scissors and achieved the recommended 60° in the vast majority of cases. If these findings translate into real life situations, then cutting episiotomies at 60° is expected to make a valuable contribution in reducing third- and fourth-degree tears in both spontaneous and operative vaginal deliveries. Variability in mediolateral episiotomies should be reduced by use of fixed-angle scissors or through validated health professional training programmes to improve visual accuracy.
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van Roon, Y., Vinayakarao, L., Melson, L. et al. Comparative study of episiotomy angles achieved by cutting with straight Mayo scissors and the EPISCISSORS-60 in a birth simulation model. Int Urogynecol J 28, 1063–1066 (2017). https://doi.org/10.1007/s00192-016-3227-x
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DOI: https://doi.org/10.1007/s00192-016-3227-x