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

AbstractIntroduction and hypothesisThis 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.MethodsWe 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®).ResultsThere 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 
Source: International Urogynecology Journal - Category: OBGYN Source Type: research

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CONCLUSION: The present analysis highlights significant differences of OASIS events pre- and post- Epi-60, that may suggest Episcissors-60 implementation as standard practice. Nonetheless, to ensure data integrity, well reported observational studies and robust randomized controlled trials (RCTs) are required prior to introduction of Epi-60 as standard episiotomy technique in clinical practice.PMID:34508991 | DOI:10.1016/j.ejogrb.2021.08.030
Source: Reproductive Biology - Category: Reproduction Medicine Authors: Source Type: research
Conclusions: This is the first study describing pregnancy outcome after fertility-preserving vNOTES procedures. vNOTES did not affect the mode of delivery or cause pregnancy-related complications. vNOTES did not increase the risk of extensive perineal tears during vaginal delivery. These preliminary data show no adverse events when vNOTES is performed in women of reproductive age. Posterior colpotomy as performed in all vNOTES procedures is by itself not an indication for an elective Caesarean section.Gynecol Obstet Invest
Source: Gynecologic and Obstetric Investigation - Category: OBGYN Source Type: research
The objective was to report the role of intrapartum ultrasound examination in affecting maternal and perinatal outcome in women undergoing instrumental vaginal delivery.Material and methodsMEDLINE, Embase, CINAHL, Google Scholar and ClinicalTrial.gov databases were searched. Inclusion criteria were randomized controlled trials comparing ultrasound assessment of fetal head position vs routine standard care (digital examination) before instrumental vaginal delivery (either vacuum or forceps). The primary outcome was failed instrumental delivery extraction followed by cesarean section. Secondary outcomes were postpartum hemor...
Source: Acta Obstetricia et Gynecologica Scandinavica - Category: OBGYN Authors: Tags: SYSTEMATIC REVIEW Source Type: research
The objective was to report the role of ultrasound in affecting maternal and perinatal outcome in women undergoing instrumental vaginal delivery.Material and methodsMEDLINE, Embase, CINAHL, Google Scholar and ClinicalTrial.gov databases were searched. Inclusion criteria were randomized controlled trials comparing ultrasound assessment of fetal head position versus routine standard care (digital examination) before instrumental vaginal delivery (either vacuum or forceps). The primary outcome was failed instrumental delivery extraction followed by cesarean section. Secondary outcomes were post-partum haemorrhage, 3rd or 4th ...
Source: Acta Obstetricia et Gynecologica Scandinavica - Category: OBGYN Authors: Tags: SYSTEMATIC REVIEW Source Type: research
ConclusionIn women with a previous vaginal delivery, one vs. two or more previous vaginal deliveries, increased birthweight, vacuum-assisted vaginal delivery and episiotomy are risk factors for OASI.
Source: International Urogynecology Journal - Category: OBGYN Source Type: research
BJOG. 2021 May 31. doi: 10.1111/1471-0528.16783. Online ahead of print.ABSTRACTOperative vaginal delivery (OVD) is recognised as a major risk factor in the occurrence of obstetric anal sphincter injuries (OASIs), particularly during first vaginal deliveries. All large observational studies based on prospectively collected databases have shown the benefits of mediolateral episiotomy performed during OVD in nulliparous women (Sultan et al. Eur J Obstet Gynecol Reprod Biol. 2019;240:192-196).PMID:34058056 | DOI:10.1111/1471-0528.16783
Source: BJOG : An International Journal of Obstetrics and Gynaecology - Category: OBGYN Authors: Source Type: research
Conclusion Prolonged second stage of labor, forceps and episiotomy are related to increased incidence of PPH, and should be used as an alert for the delivery assistants for early recognition and prompt treatment for PPH.Resumo Objetivo Identificar os fatores de risco para hemorragia p ós-parto e hemorragia pósparto grave com o sangramento pós-parto avaliado objetivamente. Métodos Trata-se de uma análise complementar de umestudo de coorte prospectivo que incluiu somente mulheres que evoluíram para parto vaginal. O total de perda sanguínea foi avaliado objetivamente durant e 2...
Source: Revista Brasileira de Ginecologia e Obstetricia - Category: OBGYN Source Type: research
This study evaluated whether episiotomy during vacuum-assisted delivery leads to fewer third- and fourth-degree tears.MethodsThis was a retrospective cohort study of all nulliparas who underwent a singleton, soft cup, vacuum-assisted vaginal delivery in one institution, from January 2014 to August 2019. Failed vacuum deliveries were excluded. Based on power analysis calculation, a sample size of 500 women in each group was sufficient to detect an advantage of episiotomy, if present. Primary outcome was third- or fourth-degree perineal tear. Secondary outcomes were other maternal complications, and low neonatal cord pH and ...
Source: Archives of Gynecology and Obstetrics - Category: OBGYN Source Type: research
Recent studies suggest prophylactic antibiotics are effective in reducing maternal postpartum (PP) infection following operative vaginal delivery (OVD). There is limited data in the US, where episiotomy and laceration repair practices may differ, affecting the risk of PP infection after OVD. We sought to evaluate whether OVD is an independent risk factor for maternal PP infection.
Source: American Journal of Obstetrics and Gynecology - Category: OBGYN Authors: Tags: Poster Session III Source Type: research
Conclusions Larger neonatal head circumference increased in 86% the risk for severe perineal trauma in this cohort of women.
Source: Female Pelvic Medicine and Reconstructive Surgery - Category: OBGYN Tags: Original Articles Source Type: research
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