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Episcissors-60™ and obstetrics anal sphincter injury: a systematic review and meta-analysis

  • Olga Divakova
  • Aethele Khunda
  • Paul A. Ballard
Original Article

Abstract

Introduction and hypothesis

The National Health Service (NHS) in England has chosen the Episcissors-60™ as one of the products included in the NHS Innovation Accelerator programme. However, the evidence for its effectiveness is scanty. We therefore set out to systematically review the literature to compare risk of obstetric anal sphincter injury (OASI) in women who had undergone episiotomy with Episcissors-60™ versus those who had an episiotomy with other scissors.

Methods

Electronic search was performed on the Healthcare Databases Advanced Search (HDAS) platform using the MEDLINE, EMBASE and CINHAL search engines up to September 2018. The search words used were ‘Episcissors-60’ or ‘episcissors 60.’ Studies were included if patients who had episiotomies with Episcissors-60™ were compared with parallel or historic patients who had episiotomy with other scissors. The only restriction used was “human” studies.

Results

Of the initial 21 citations, 4 studies had enough information to be included in the meta-analysis. The number of study participants ranged from 63 to 4314. When comparing 797 patients who had episiotomies with Episcissors-60™ to 1122 patients who had episiotomies with other scissors, there was a significant reduction in OASI: risk difference = −0.04 (95% CI = −0.07 to −0.01; p = 0.005, I2 = 41%). The number needed to treat was 25 (95% CI = 14–100). This was not associated with an increase in episiotomy rate.

Conclusions

We reported the first systematic review on the effect of Episcissors-60™ on OASI rate. Although the studies are few, and of small size and low quality, the results are promising in terms of possible reduction in OASI.

Keywords

Episcissors-60 Episiotomy Obstetric anal sphincter injury 

Notes

Acknowledgements

The authors thank Mr. Ashish Pradhan and Dr. Ajay Bini for sharing their data with us.

Compliance with ethical standards

Conflicts of interest

Olga Divakova: None.

Aethele Khunda: Educational travel grant from Medronic plc.

Paul Ballard: None.

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Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.James Cook University HospitalSouth Tees NHS TrustMiddlesbroughUK
  2. 2.LondonUK

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