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Randomized trial comparing episiotomies with Braun-Stadler episiotomy scissors and EPISCISSORS-60(®)
INTRODUCTION: Episiotomy angle is a crucial factor in causation of obstetric anal sphincter injuries (OASIS), which are the major cause of female bowel incontinence. Sutured episiotomies angled too close to the midline (<30 degree) or too far away from the midline (>60 degree) fail to unload t...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Dove Medical Press
2015
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4459625/ https://www.ncbi.nlm.nih.gov/pubmed/26082666 http://dx.doi.org/10.2147/MDER.S83360 |
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author | Sawant, Ganpat Kumar, Divya |
author_facet | Sawant, Ganpat Kumar, Divya |
author_sort | Sawant, Ganpat |
collection | PubMed |
description | INTRODUCTION: Episiotomy angle is a crucial factor in causation of obstetric anal sphincter injuries (OASIS), which are the major cause of female bowel incontinence. Sutured episiotomies angled too close to the midline (<30 degree) or too far away from the midline (>60 degree) fail to unload the perineum sufficiently and predispose to OASIS. A 25-degree post-delivery episiotomy suture angle has a 10% risk of OASIS while 45-degree episiotomy is associated with 0.5% risk. To account for perineal distension at crowning, a 60-degree episiotomy incision is required to achieve 43–50 degree suture angles. We compared episiotomy suture angles with commonly used Braun-Stadler episiotomy scissors with the new fixed angle EPISCISSORS-60(®). METHODS: Ethical approval was obtained. A prospective cluster randomization design was chosen. Thirty-one patients were required in each group for a 12-degree difference with power at 90% and 5% significance. Sutured episiotomy angles and post-delivery linear distance from caudal end of the sutured episiotomy to the anus were measured with protractors and rulers. Two-tailed t-tests were used to compare the two groups. RESULTS: Thirty-one nulliparae had episiotomies with EPISCISSORS-60(®), 32 with Braun-Stadler. Mean age (25 versus 24.8 years) was similar. EPISCISSORS-60(®) episiotomies were angled 12 degrees more laterally away from the anus compared to Braun-Stadler (40.6 degrees, 95% confidence interval [CI] ±2, interquartile range [IQR] 35–45 versus 28.3 degrees, 95% CI ±2, IQR 25–30, P<0.0001). The post-delivery linear distance from caudal end of the sutured episiotomy to the anus was 15 mm more with the EPISCISSORS-60(®) compared to Braun-Stadler (35 mm, 95% CI ±2.2, IQR =30–39 versus 19.5; 95% CI ±1.3, IQR =14.75–22.25 P<0.0001). EPISCISSORS-60(®) episiotomies measured longer (47 mm versus 40 mm, P<0.0001). There were no OASIS cases in the EPISCISSORS-60(®) group versus one in the Braun-Stadler group. CONCLUSION: The EPISCISSORS-60(®) sutured episiotomies are much further away from the midline in angular and distance measures, hence at lower OASIS risk. |
format | Online Article Text |
id | pubmed-4459625 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Dove Medical Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-44596252015-06-16 Randomized trial comparing episiotomies with Braun-Stadler episiotomy scissors and EPISCISSORS-60(®) Sawant, Ganpat Kumar, Divya Med Devices (Auckl) Original Research INTRODUCTION: Episiotomy angle is a crucial factor in causation of obstetric anal sphincter injuries (OASIS), which are the major cause of female bowel incontinence. Sutured episiotomies angled too close to the midline (<30 degree) or too far away from the midline (>60 degree) fail to unload the perineum sufficiently and predispose to OASIS. A 25-degree post-delivery episiotomy suture angle has a 10% risk of OASIS while 45-degree episiotomy is associated with 0.5% risk. To account for perineal distension at crowning, a 60-degree episiotomy incision is required to achieve 43–50 degree suture angles. We compared episiotomy suture angles with commonly used Braun-Stadler episiotomy scissors with the new fixed angle EPISCISSORS-60(®). METHODS: Ethical approval was obtained. A prospective cluster randomization design was chosen. Thirty-one patients were required in each group for a 12-degree difference with power at 90% and 5% significance. Sutured episiotomy angles and post-delivery linear distance from caudal end of the sutured episiotomy to the anus were measured with protractors and rulers. Two-tailed t-tests were used to compare the two groups. RESULTS: Thirty-one nulliparae had episiotomies with EPISCISSORS-60(®), 32 with Braun-Stadler. Mean age (25 versus 24.8 years) was similar. EPISCISSORS-60(®) episiotomies were angled 12 degrees more laterally away from the anus compared to Braun-Stadler (40.6 degrees, 95% confidence interval [CI] ±2, interquartile range [IQR] 35–45 versus 28.3 degrees, 95% CI ±2, IQR 25–30, P<0.0001). The post-delivery linear distance from caudal end of the sutured episiotomy to the anus was 15 mm more with the EPISCISSORS-60(®) compared to Braun-Stadler (35 mm, 95% CI ±2.2, IQR =30–39 versus 19.5; 95% CI ±1.3, IQR =14.75–22.25 P<0.0001). EPISCISSORS-60(®) episiotomies measured longer (47 mm versus 40 mm, P<0.0001). There were no OASIS cases in the EPISCISSORS-60(®) group versus one in the Braun-Stadler group. CONCLUSION: The EPISCISSORS-60(®) sutured episiotomies are much further away from the midline in angular and distance measures, hence at lower OASIS risk. Dove Medical Press 2015-06-01 /pmc/articles/PMC4459625/ /pubmed/26082666 http://dx.doi.org/10.2147/MDER.S83360 Text en © 2015 Sawant and Kumar. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. |
spellingShingle | Original Research Sawant, Ganpat Kumar, Divya Randomized trial comparing episiotomies with Braun-Stadler episiotomy scissors and EPISCISSORS-60(®) |
title | Randomized trial comparing episiotomies with Braun-Stadler episiotomy scissors and EPISCISSORS-60(®) |
title_full | Randomized trial comparing episiotomies with Braun-Stadler episiotomy scissors and EPISCISSORS-60(®) |
title_fullStr | Randomized trial comparing episiotomies with Braun-Stadler episiotomy scissors and EPISCISSORS-60(®) |
title_full_unstemmed | Randomized trial comparing episiotomies with Braun-Stadler episiotomy scissors and EPISCISSORS-60(®) |
title_short | Randomized trial comparing episiotomies with Braun-Stadler episiotomy scissors and EPISCISSORS-60(®) |
title_sort | randomized trial comparing episiotomies with braun-stadler episiotomy scissors and episcissors-60(®) |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4459625/ https://www.ncbi.nlm.nih.gov/pubmed/26082666 http://dx.doi.org/10.2147/MDER.S83360 |
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