Evaluation of Accuracy of Episiotomy Incision in a Governmental Maternity Unit in Palestine: An Observational Study

Hadil Y Ali-Masri, Sahar J Hassan, Kaled M Zimmo, Mohammed W Zimmo, Khaled M K Ismail, Erik Fosse, Hasan Alsalman, Åse Vikanes, Katariina Laine, Hadil Y Ali-Masri, Sahar J Hassan, Kaled M Zimmo, Mohammed W Zimmo, Khaled M K Ismail, Erik Fosse, Hasan Alsalman, Åse Vikanes, Katariina Laine

Abstract

Episiotomy should be cut at certain internationally set criteria to minimize risk of obstetric anal sphincter injuries (OASIS) and anal incontinence. The aim of this study was to assess the accuracy of cutting right mediolateral episiotomy (RMLE). An institution-based prospective cohort study was undertaken in a Palestinian maternity unit from February 1, to December 31, 2016. Women having vaginal birth at gestational weeks ≥24 or birthweight ≥1000 g and with intended RMLE were eligible (n=240). Transparent plastic films were used to trace sutured episiotomy in relation to the midline within 24-hour postpartum. These were used to measure incisions' distance from midline, and suture angles were used to classify the incisions into RMLE, lateral, and midline episiotomy groups. Clinical characteristics and association with OASIS were compared between episiotomy groups. A subanalysis by profession (midwife or trainee doctor) was done. Less than 30% were RMLE of which 59% had a suture angle of <40° (equivalent to an incision angle of <60°). There was a trend of higher OASIS rate, but not statistically significant, in the midline (16%, OR: 1.7, CI: 0.61-4.5) and unclassified groups (16.5%, OR: 1.8, CI: 0.8-4.3) than RMLE and lateral groups (10%). No significant differences were observed between episiotomies cut by doctors and midwives. Most of the assessed episiotomies lacked the agreed criteria for RMLE and had less than optimal incision angle which increases risk of severe complications. A well-structured training program on how to cut episiotomy is recommended.

References

    1. Carroli G., Mignini L. Episiotomy for vaginal birth. Cochrane Database of Systematic Reviews. 2009;1 doi: 10.1002/14651858.cd000081.pub2.Cd000081
    1. Jiang H., Qian X., Carroli G., Garner P. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database of Systematic Reviews. 2017;2 doi: 10.1002/14651858.CD000081.pub3.Cd000081
    1. Frankman E. A., Wang L., Bunker C. H., Lowder J. L. Episiotomy in the United States: has anything changed? American Journal of Obstetrics and Gynecology. 2009;200(5):573.e1–573.e7. doi: 10.1016/j.ajog.2008.11.022.
    1. Kozhimannil K. B., Karaca-Mandic P., Blauer-Peterson C. J., Shah N. T., Snowden J. M. Uptake and utilization of practice guidelines in hospitals in the United States: the case of routine episiotomy. Joint Commission Journal on Quality and Patient Safety. 2017;43(1):41–48. doi: 10.1016/j.jcjq.2016.10.002.
    1. Laine K., Gissler M., Pirhonen J. Changing incidence of anal sphincter tears in four Nordic countries through the last decades. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2009;146(1):71–75. doi: 10.1016/j.ejogrb.2009.04.033.
    1. Clesse C., Lighezzolo-Alnot J., De Lavergne S., Hamlin S., Scheffler M. Statistical trends of episiotomy around the world: comparative systematic review of changing practices. Health Care for Women International. 2018;39(6):644–662. doi: 10.1080/07399332.2018.1445253.
    1. Khresheh R., Homer C., Barclay L. A comparison of labour and birth outcomes in Jordan with WHO guidelines: a descriptive study using a new birth record. Midwifery. 2009;25(6):e11–e18. doi: 10.1016/j.midw.2007.10.007.
    1. Frass K. A., Al-Harazi A. H. Episiotomy is still performed routinely in Yemeni women. Saudi Medical Journal. 2010;31(7):764–767.
    1. Kalis V., Laine K., de Leeuw J. W., Ismail K. M., Tincello D. G. Classification of episiotomy: towards a standardisation of terminology. BJOG. 2012;119(5):522–526. doi: 10.1111/j.1471-0528.2011.03268.x.
    1. Kalis V., Stepan J., Jr., Horak M., Roztocil A., Kralickova M., Rokyta Z. Definitions of mediolateral episiotomy in Europe. International Journal of Gynecology and Obstetrics. 2008;100(2):188–189. doi: 10.1016/j.ijgo.2007.07.022.
    1. Sooklim R., Thinkhamrop J., Lumbiganon P., et al. The outcomes of midline versus medio-lateral episiotomy. Reproductive Health. 2007;4(1):p. 10. doi: 10.1186/1742-4755-4-10.
    1. Dandolu V., Chatwani A., Harmanli O., Floro C., Gaughan J. P., Hernandez E. Risk factors for obstetrical anal sphincter lacerations. International Urogynecology Journal. 2005;16(4):304–307. doi: 10.1007/s00192-005-1297-2.
    1. Tincello D. G., Williams A., Fowler G. E., Adams E. J., Richmond D. H., Alfirevic Z. Differences in episiotomy technique between midwives and doctors. BJOG. 2003;110(12):1041–1044. doi: 10.1111/j.1471-0528.2003.03030.x.
    1. Eogan M., Daly L., O’Connell P. R., O’Herlihy C. Does the angle of episiotomy affect the incidence of anal sphincter injury? BJOG. 2006;113(2):190–194. doi: 10.1111/j.1471-0528.2005.00835.x.
    1. Stedenfeldt M., Pirhonen J., Blix E., Wilsgaard T., Vonen B., Øian P. Episiotomy characteristics and risks for obstetric anal sphincter injuries: a case-control study. BJOG. 2012;119(6):724–730. doi: 10.1111/j.1471-0528.2012.03293.x.
    1. Kalis V., Landsmanova J., Bednarova B., Karbanova J., Laine K., Rokyta Z. Evaluation of the incision angle of mediolateral episiotomy at 60 degrees. International Journal of Gynecology and Obstetrics. 2011;112(3):220–224. doi: 10.1016/j.ijgo.2010.09.015.
    1. National Institute for Health and Care Excellence. Intrapartum Care for Healthy Women and Babies (CG190) London: NICE Guidelines; 2014.
    1. Palestinian Central Bureau of Statistics. Demographic and Health Survey–2004: Final Report. PCB, Ramallah–Palestine. , December 2006.
    1. Wick L., Mikki N., Giacaman R., Abdul-Rahim H. Childbirth in Palestine. International Journal of Gynecology and Obstetrics. 2005;89(2):174–178. doi: 10.1016/j.ijgo.2005.01.029.
    1. Zimmo K., Laine K., Fosse E., et al. Episiotomy practice in six Palestinian hospitals: a population-based cohort study among singleton vaginal births. BMJ Open. 2018;8(7) doi: 10.1136/bmjopen-2018-021629.e021629
    1. Fodstad K., Laine K., Staff A. C. Different episiotomy techniques, postpartum perineal pain, and blood loss: an observational study. International Urogynecology Journal. 2013;24(5):865–872. doi: 10.1007/s00192-012-1960-3.
    1. Kalis V., Karbanova J., Horak M., Lobovsky L., Kralickova M., Rokyta Z. The incision angle of mediolateral episiotomy before delivery and after repair. International Journal of Gynecology and Obstetrics. 2008;103(1):5–8. doi: 10.1016/j.ijgo.2008.05.026.
    1. Hassan S., Vikanes A., Laine K., et al. Building a research registry for studying birth complications and outcomes in six Palestinian governmental hospitals. BMC Pregnancy Childbirth. 2017;17(1):p. 112. doi: 10.1186/s12884-017-1296-6.
    1. Andrews V., Thakar R., Sultan A. H., Jones P. W. Are mediolateral episiotomies actually mediolateral? BJOG. 2005;112(8):1156–1158. doi: 10.1111/j.1471-0528.2005.00645.x.
    1. Naidu M., Kapoor D. S., Evans S., Vinayakarao L., Thakar R., Sultan A. H. Cutting an episiotomy at 60 degrees: how good are we? International Urogynecology Journal. 2015;26(6):813–816. doi: 10.1007/s00192-015-2625-9.
    1. Van Roon Y., Kirwin C., Rahman N., et al. Comparison of obstetric anal sphincter injuries in nulliparous women before and after introduction of the EPISCISSORS-60 (®) at two hospitals in the United Kingdom. International Journal of Women’s Health. 2015;7:949–955. doi: 10.2147/IJWH.S94680.
    1. Sultan A. H., Kamm M. A., Hudson C. N. Obstetric perineal tears: an audit of training. Journal of Obstetrics and Gynaecology. 1995;15(1):19–23. doi: 10.3109/01443619509007724.
    1. Silf K., Woodhead N., Kelly J., Fryer A., Kettle C., Ismail K. M. Evaluation of accuracy of mediolateral episiotomy incisions using a training model. Midwifery. 2015;31(1):197–200. doi: 10.1016/j.midw.2014.08.009.

Source: PubMed

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