Skip to main content
SpringerLink
Log in

Impact of the EPISCISSORS-60 mediolateral episiotomy scissors on obstetric anal sphincter injuries: a 2-year data review in the United Kingdom

  • Review Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

This time-series analysis was carried out to determine if the use of the EPISCISSORS-60®, episiotomy scissors specifically designed to achieve a cutting angle of 60°, would continue to sustain obstetric anal sphincter injuries (OASIS) reductions at our hospital 2 years after its introduction.

Methods

We compared data from 2,342 women delivered in 2014 (prior to the introduction of EPISCISSORS-60®) with that of 4,498 women delivered from 2016 to 2017 (after the introduction of EPISCISSORS-60®).

Results

There was a reduction of OASIS in all nulliparous vaginal deliveries (NVD; 7.2% vs 5.1% p = 0.05), and a 50% reduction of OASIS (7.5% vs 3.7%) in operative vaginal deliveries (OVD) (p = 0.02). There was a statistically significant association between episiotomies performed with EPISCISSORS-60® and a reduction in OASIS (SVD: 6.9% vs 1.5% p = 0.006; OVD:28.6% vs 2.6% p < 0.0001). Additionally, there was an increase in the use of episiotomies in all nulliparous vaginal deliveries (29% vs 33.7%; p = 0.01). We also found a 78% reduction of OASIS with episiotomies compared with no episiotomies in the 2016–2017 group (6.9% vs 1.5% p = 0.006).

Conclusions

Our results suggest that there might have been a sustained reduction in OASIS rates associated with using EPISCISSORS-60®.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. RCOG (2015) Greentop guideline 29: The Management of Third- and Fourth-Degree Perineal tears. Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-29.pdf.

  2. Anderson A (2013) Ten years of maternity claims: an analysis of NHS litigation authority data. National Health Service Litigation Authority (NHSLA). Available at: https://doi.org/10.1177/1356262213486434.

  3. Ampt AJ, Roberts CL, Morris JM, Ford JB. The impact of first birth obstetric anal sphincter injury on the subsequent birth: a population-based linkage study. BMC Pregnancy Childbirth. 2015;15:31. https://doi.org/10.1186/s12884-015-0469-4.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Basu M, Smith D, Edwards R, STOMP project team. Can the incidence of obstetric anal sphincter injury be reduced? The STOMP experience. Eur J Obstet Gynecol Reprod Biol. 2016;202:55–9. https://doi.org/10.1016/j.ejogrb.2016.04.033.

    Article  PubMed  Google Scholar 

  5. Fritel X, Schaal JP, Fauconnier A, Bertrang V, Levet C, Pigne A. Pelvic floor disorders 4 years after first delivery: a comparative study of restrictive versus systematic episiotomy. BJOG. 2008;115:247–52.

    Article  CAS  Google Scholar 

  6. Vogel D, van der Leeuw-van Beek A, Gietelink D, Vujkovic M, de Leeuw JW, van Bavel J. The effect of a mediolateral episiotomy during operative vaginal delivery on the risk of developing obstetrical anal sphincter injuries. Am J Obstet Gynecol. 2012;206:404.e1–5. https://doi.org/10.1016/j.ajog.2012.02.00.

    Article  Google Scholar 

  7. Räisänen S, Vehviläinen-Julkunen K, Heinonen S. Need for and consequences of episiotomy in vaginal birth: a critical approach. Midwifery. 2010;26:348–56. https://doi.org/10.1016/j.midw.2008.07.007.

    Article  PubMed  Google Scholar 

  8. Gurol-Urganci I, Cromwell DA, Edozien LC, Mahmood TA, Adams EJ, Richmond DH, et al. Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors. BJOG. 2013;120:1516–25. https://doi.org/10.1111/1471-0528.12363.

    Article  CAS  PubMed  Google Scholar 

  9. Eogan M, Daly L, O'Connell PR, O'Herlihy C. Does the angle of episiotomy affect the incidence of anal sphincter injury? BJOG. 2006;113:190–4.

    Article  CAS  Google Scholar 

  10. Stedenfeldt M, Pirhonen J, Blix E, Wilsqaard T, Vonen B, Qian P. Episiotomy characteristics and risks for obstetric anal sphincter injury: a case-control study. BJOG. 2012;119:724–30. https://doi.org/10.1111/j.1471-0528.2012.03293.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Andrews V, Thakar R, Sultan AH, Jones PW. Are mediolateral episiotomies actually mediolateral? BJOG. 2005;112:1156–8.

    Article  Google Scholar 

  12. Naidu M, Kapoor DS, Evans S, Vinayakarao L, Thakar R, Sultan AH. Cutting an episiotomy at 60 degrees: how good are we? Int Urogynecol J. 2005;26(6):813–6. https://doi.org/10.1007/s00192-015-2625-9.

    Article  Google Scholar 

  13. Silf K, Woodhead N, Kelly J, Fryer A, Kettle C, Ismail KM. Evaluation of accuracy of mediolateral episiotomy incisions using a training model. Midwifery. 2015;31(1):197–200. https://doi.org/10.1016/j.midw.2014.08.009.

    Article  CAS  PubMed  Google Scholar 

  14. Freeman RM, Hollands H, Barron L, Kapoor DS. Cutting a mediolateral episiotomy at the correct angle: evaluation of a new device: the Episcissors-60. Med Devices (Auckl). 2014;7:23–8. https://doi.org/10.2147/MDER.S60056.

    Article  CAS  Google Scholar 

  15. Patel RP, Ubale SM. Evaluation of the angled Episcissors-60(®) episiotomy scissors in spontaneous vaginal deliveries. Med Devices (Auckl). 2014;7:253–6. https://doi.org/10.2147/MDER.S66901.

    Article  Google Scholar 

  16. Sawant G, Kumar D. Randomized trial comparing episiotomies with Braun-Stadler episiotomy scissors and EPISCISSORS-60(®). Med Devices (Auckl). 2015;8:251–4. https://doi.org/10.2147/MDER.S83360.

    Article  Google Scholar 

  17. Van Roon Y, Kirwin C, Rahman N, Vinayakarao L, Melson L, Kester N, et al. Comparison of obstetric anal sphincter injuries in nulliparous women before and after introduction of the EPISCISSORS-60 at two hospitals in the United Kingdom. Int J Women’s Health. 2015;7:949–55.

    Article  Google Scholar 

  18. Mohiudin H, Ali S, Pisal PN, Villar R. Implementation of the RCOG guidelines for prevention of obstetric anal sphincter injuries (OASIS) at two London hospitals: a time series analysis. Eur J Obstet Gynecol Reprod Biol. 2018;224:89–92.

    Article  Google Scholar 

  19. Divakova O, Khunda A, Ballard PA. Episcissors-60™ and obstetrics anal sphincter injury: a systematic review and meta-analysis. Int Urogynecol J. 2019. https://doi.org/10.1007/s00192-019-03901-4.

    Article  PubMed  Google Scholar 

  20. Cole J, Lacey L, Bulchandani S. The use of Episcissors-60 to reduce the rate of obstetric anal sphincter injuries: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2019;237:23–7. https://doi.org/10.1016/j.ejogrb.2019.04.004.

    Article  PubMed  Google Scholar 

  21. Sultan AH, Thakar R, Ismail KM, Kalis V, Laine K, Räisänen SH, et al. The role of mediolateral episiotomy during operative vaginal delivery. Eur J Obstet Gynecol Reprod Biol. 2019;240:192–6. https://doi.org/10.1016/j.ejogrb.2019.07.005.

    Article  CAS  PubMed  Google Scholar 

  22. Laine K, Skjeldestad FE, Sandvik L, Staff AC. Incidence of obstetric anal sphincter injuries after training to protect the perineum: cohort study. BMJ Open. 2012;2:e001649.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Peterborough City Hospital, North West Anglia Foundation NHS trust, Peterborough, UK

    Li Mei Koh

  2. Department of Obstetrics and Gynaecology, Hinchingbrooke Hospital, North West Anglia Foundation NHS Trust, Huntingdon, UK

    Yves van Roon & Sangeeta Pathak

  3. Department of Obstetrics and Gynaecology, Addenbrookes Hospital, Cambridge, UK

    Ashish Pradhan

  4. Hinchingbrooke Hospital, North West Anglia NHS Foundation Trust, Huntingdon, PE29 6NT, UK

    Sangeeta Pathak

Authors
  1. Li Mei Koh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yves van Roon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ashish Pradhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sangeeta Pathak
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LMK: manuscript writing/editing; YVR: data collection; AP: data collection; SP: data collection/analysis, manuscript editing.

Corresponding author

Correspondence to Sangeeta Pathak.

Ethics declarations

Conflicts of interest

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Koh, L.M., van Roon, Y., Pradhan, A. et al. Impact of the EPISCISSORS-60 mediolateral episiotomy scissors on obstetric anal sphincter injuries: a 2-year data review in the United Kingdom. Int Urogynecol J 31, 1729–1734 (2020). https://doi.org/10.1007/s00192-019-04201-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-019-04201-7

Keywords

Search

Navigation