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Related Experiment Videos

Episiotomy: What angle do you cut to the midline?

Kenneth Ma1, Louise Byrd1

  • 1Obstetric Department, St Mary's Hospital, Central Manchester Foundation Trust, Manchester, UK.

European Journal of Obstetrics, Gynecology, and Reproductive Biology
|April 27, 2017
PubMed
Summary

Midwives and obstetric trainees have varied episiotomy techniques, increasing the risk of obstetric anal sphincter injuries (OASIS). Improving technique is crucial for reducing OASIS and fecal incontinence. This study highlights the need for targeted training programs.

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Area of Science:

  • Obstetrics and Gynecology
  • Surgical Techniques
  • Patient Safety

Background:

  • Episiotomy technique varies among healthcare providers, influencing obstetric anal sphincter injuries (OASIS) risk.
  • Standardizing episiotomy angles is critical for minimizing severe perineal trauma and subsequent complications like fecal incontinence.

Purpose of the Study:

  • To analyze differences in episiotomy techniques among obstetricians and midwives.
  • To identify specific areas for training to improve episiotomy practice and reduce OASIS incidence.

Main Methods:

  • Prospective practice survey of 101 healthcare professionals (midwives, junior trainees, senior trainees, consultants) in a tertiary referral unit.
  • Participants performed a simulated episiotomy, with incision angle, length, and starting distance recorded.
Keywords:
AngleAngle of episiotomiesEpisiotomiesEpisiotomyOASISObstetric anal sphincter injuriesTechnique of episiotomies

Related Experiment Videos

  • Statistical analysis using one-way ANOVA to compare techniques across different grades.

    • Main Results:

    • Mean episiotomy angles varied significantly: midwives (47°), junior trainees (51°), senior trainees (66°), and consultants (77°).
    • Midwives' mean incision angle differed significantly from senior trainees (p>0.01) and consultants (p<0.01).
    • 45% of midwives performed episiotomies <45° to the midline, compared to 7% of senior trainees and 0% of consultants.

    Conclusions:

    • Significant deficiencies exist in episiotomy technique among obstetric trainees and midwives.
    • Standardized training is essential to improve episiotomy performance and reduce OASIS and fecal incontinence rates.
    • Findings should guide the development of targeted training programs to enhance patient outcomes.