Episiotomy: Are Indian Obstetricians Getting the Angle Right?

Area of Science:

• Obstetrics and Gynecology
• Surgical Education
• Patient Safety

Background:

• Mediolateral episiotomy at a 60° angle is recommended to prevent obstetric anal sphincter injuries (OASIs).
• Improper episiotomy angles, too close or distant to the anus, increase the risk of OASIs.
• This study assessed obstetricians' knowledge and practical ability regarding the recommended episiotomy angle in India.

Purpose of the Study:

• To evaluate obstetricians' understanding of the correct episiotomy angle for OASI prevention.
• To assess the accuracy with which obstetricians can draw the recommended episiotomy angle.
• To identify gaps in knowledge and practice related to episiotomy angles.

Main Methods:

• A survey was conducted among 140 obstetricians in India prior to OASI prevention and repair workshops.
• Participants were asked to verbally describe and visually draw the recommended episiotomy angle on a perineal replica.
• Inter-rater reliability (ICC) and standard errors of measurement (SEM) were calculated to assess agreement between described and drawn angles.

Main Results:

• Only 47.9% of obstetricians correctly described the 60° episiotomy angle.
• A mere 2.2% accurately drew a 60° angle, with slightly more (8.7%) drawing within a 2° margin.
• Poor agreement was found between described and drawn angles (ICC = 0.18), with a significant SEM of ±12.2°.

Conclusions:

• There is a significant deficit in knowledge regarding the recommended episiotomy angle among surveyed obstetricians.
• Obstetricians demonstrate poor accuracy in estimating and drawing the correct episiotomy angle.
• The findings underscore the necessity for standardized national guidelines, structured training programs, and potentially the use of angle-measuring devices to minimize preventable harm.