title: Evaluation of accuracy of mediolateral episiotomy incisions using a training model.
abstract: BACKGROUND
  Episiotomy is one of the most commonly performed surgical procedures worldwide. In the UK the use of episiotomy is selective, rather than routine, and a right mediolateral episiotomy (RMLE) is considered standard practice. According to The National Institute of Health and Care Excellence (NICE, 2007) guideline for intrapartum care such an episiotomy should be cut at an angle between 45° and 60° to the vertical axis. Recent evidence suggests that the angle of incision of mediolateral episiotomy (MLE) is associated with risk of obstetric anal sphincter injury (OASIS).
  
  
  OBJECTIVE
  to assess the accuracy of individual practitioner's techniques when performing a RMLE.
  
  
  METHODS
  an audit of practice against nationally set standards.
  
  
  METHODS
  at a national midwifery conference and prior to three multiprofessional perineal repair training workshops in the West Midlands region of the UK.
  
  
  METHODS
  144 midwives and 53 obstetric trainees.
  
  
  METHODS
  practitioners were asked to perform a RMLE incision on a bespoke training model, which is designed to give a realistic representation of a stretched perineum at crowning of the baby's head. Four parameters were measured: (1) distance of the starting point from the midline; (2) angle subtended to the perpendicular; (3) length and (4) shape of the incision (curved, straight or J-shaped).
  
  
  RESULTS
  of the 197 incisions performed only 12.7% (14.6%, n=21/144 of midwives and 7.5%, n=4/53 of obstetricians) complied with the defined technique of a RMLE for correctness of angle and placement. A 2-sided Fisher's exact test showed no significant difference between previous attendance at perineal management training and incision accuracy.
authors.affiliation: Department of Obstetrics & Gynaecology, University Hospital Crosshouse, Kilmarnock Road, Crosshouse, Kilmarnock, East Ayrshire KA2 0BE, UK. Electronic address: ksilf@hotmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Silf
authors.affiliation: Birmingham Centre for Women and Children׳s Health, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2 TT, UK. Electronic address: nwoodhead@doctors.org.uk.
authors.forename: N
authors.initials: N
authors.lastname: Woodhead
authors.affiliation: The Maternity Centre, University Hospital of North Staffordshire, Stoke-on-Trent ST4 6QG, UK. Electronic address: june.kelly@uhns.nhs.uk.
authors.forename: J
authors.initials: J
authors.lastname: Kelly
authors.affiliation: Institute of Science and Technology in Medicine, Keele University Medical School, Thornburrow Drive, ST4 7QB Staffordshire, UK. Electronic address: Anthony.Fryer@uhns.nhs.uk.
authors.forename: A
authors.initials: A
authors.lastname: Fryer
authors.affiliation: Faculty of Health Sciences, Staffordshire University, Blackheath Lane, Stafford ST18 0AD, UK. Electronic address: C.Kettle@staffs.ac.uk.
authors.forename: C
authors.initials: C
authors.lastname: Kettle
authors.affiliation: Birmingham Centre for Women and Children׳s Health, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2 TT, UK. Electronic address: K.ismail@bham.ac.uk.
authors.forename: K M K
authors.initials: KM
authors.lastname: Ismail
mesh_terms: D001003:Anal Canal / Q000293:injuries; D004841:Episiotomy / Q000592:standards*; D005260:Female; D006801:Humans; D008880:Midwifery / Q000193:education* / Q000592:standards; D007744:Obstetric Labor Complications / Q000601:surgery*; D009774:Obstetrics / Q000193:education* / Q000592:standards; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D000066908:Simulation Training / Q000379:methods*; D013663:Teaching / Q000379:methods; D006113:United Kingdom
keywords: Childbirth; Episiotomy; Midwifery; Obstetrics; Perineum