title: Cutting an episiotomy at 60 degrees: how good are we?
abstract: OBJECTIVE
  Episiotomy is regarded as the most common maternal obstetric surgical procedure. It is associated with a significant increase in blood loss, lower pelvic floor muscle strength, dyspareunia, and perineal pain compared with a perineal tear. We tested the hypothesis that all doctors and midwives can perform an episiotomy when prompted to, specifically cut at 60° from the midline (in a simulation model).
  
  
  METHODS
  Doctors and midwives attending the BMFMS Annual Meeting (2014), Croydon Perineal Trauma Course and staff at Poole General Hospital were invited to cut a paper replica of the perineum with a commonly used episiotomy incision pad. Participants were prompted to cut an episiotomy at 60° to the perineal midline with the anus as a reference point. The angles and distances were measured using protractors and rulers. A 58-62° band was deemed acceptable to account for measurement errors.
  
  
  RESULTS
  A total of 106 delegates participated. Only 15 % of doctors and midwives cut an episiotomy between 58 and 62°. Over one third (36 %) cut the episiotomy between 55 and 65° (inclusive). Nearly two thirds either underestimated the angle (<55°; 44 %), or overestimated the angle (>66°; 18 %). Thirty-six and 7.5 % of episiotomies were cut at <50 and >70° respectively. The origination point of the episiotomy was 5 mm away from the midline (IQR 1-8 mm).
  
  
  CONCLUSIONS
  This original observational study shows that doctors and midwives were poor at cutting at the prompted episiotomy angle of 60°. This highlights the need to develop structured training programmes to improve the visual accuracy of estimating angles or the use of fixed angle devices to help improve the ability to estimate the desired angle.
authors: Croydon University Hospital, 530, London Road, Croydon, CR7 7YE, UK.
authors: Madhu
authors: M
authors: Naidu
authors: Dharmesh S
authors: DS
authors: Kapoor
authors: Sarah
authors: S
authors: Evans
authors: Latha
authors: L
authors: Vinayakarao
authors: Ranee
authors: R
authors: Thakar
authors: Abdul H
authors: AH
authors: Sultan
mesh_terms: D001003:Anal Canal / Q000293:injuries; D002983:Clinical Competence; D004841:Episiotomy / Q000009:adverse effects / Q000193:education / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans
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