Guided mediolateral episiotomy to minimise the risk of obstetric anal sphincter injury
What is the problem?
Approximately 15% of births in England require an episiotomy. An episiotomy is a cut made by a doctor or midwife in the area between the vagina and anus (the perineum) during childbirth. It makes the opening of the vagina a bit wider, allowing the baby to come through it more easily.
Of the childbirths requiring an episiotomy, around 25% experience obstetric anal sphincter injuries (also known as OASIS). This can have a devastating impact on the quality of a new mother’s life. Repair of OASIS injuries, litigation and elective caesarean sections cost the NHS £57 million annually.
According to available evidence, what is the suggested solution?
The angle of the cut is important in reducing injuries from episiotomies. NICE Guidance recommends that cuts need to be between 45 and 60 degrees to improve patient experience and outcomes and reduce OASIS repair and litigation. Recent published evidence shows using angled scissors can lead to a reduction in OASIS of between 18-50%.
Episcissors-60 are an example of a product that may help solve this problem. Episcissors-60 are patented fixed angle scissors that take away human error in estimating episiotomy angles during childbirth. This innovation reduces the risk of complications associated with standard practice episiotomies.
“The Episcissors‑60 are designed to guide an accurate mediolateral episiotomy at 60 degrees to the perineal midline. They provide an alternative to standard episiotomy scissors, for which the cutting angle must be estimated” (NICE MIB33)
Evidence suggests that Episcissors-60 may halve the annual number of OASIS injuries per year. To find the data on OASIS injuries for your hospital, search for your Trust on the Royal College of Obstetricians and Gynaecologists 18 maternity indicators. The number of episiotomy procedures carried out and the proportion of third and fourth degree perineal tears can be found under indicators five and six.
You can find out more about episiotomy and the evidence base for using angled scissors such as Episcissors-60 by following the related links on the right.
Where can I find out more about implementation?
The Department of Health have centrally procured a number of angled episiotomy scissors and providers may purchase the appropriate product via the NHS Supply chain website. For this theme NHS England will reimburse providers £16 per patient use. Click here to order from NHS Supply Chain.