title: Episiotomy preferences, indication, and classification--a survey among Nordic doctors.
abstract: BACKGROUND
  Episiotomy performance impacts perineal health and rates of obstetric anal sphincter injuries (OASIS). Our objective was to assess self-reported episiotomy practice and opinions on clinical indication for episiotomy among Nordic physicians and to investigate potential misclassification.
  
  
  METHODS
  A survey was conducted among doctors attending the 2012 Nordic obstetrical and gynecological conference. Participants were asked to draw an episiotomy on a photo of a perineum with a crowning fetal head similarly to their clinical practice if an episiotomy was clinically indicated, and to name the technique drawn. Differences in outcome measures were compared by country of practice and seniority.
  
  
  RESULTS
  The majority of the 297 participants (47%) drew a lateral episiotomy according to our classification by incision point and angle, but as many as 64% of these 138 doctors misclassified this as mediolateral episiotomy. Only 20% drew a mediolateral episiotomy, the great majority classifying it accurately, but 8% misclassified their mediolateral cut as a lateral episiotomy. One-third of episiotomies were nonclassifiable. In general, doctors in Finland, Sweden, and Norway more often favored lateral episiotomies compared with doctors in Denmark and Iceland. There were significant differences between Finnish and Norwegian vs. Danish and Swedish doctors in perception of clinical indications for episiotomy.
  
  
  CONCLUSIONS
  The great variation in self-reported episiotomy performance between Nordic physicians and large misclassification rates indicate that educational programs are warranted. Use of uniform classification and appropriate techniques may be crucial to investigate the role of episiotomies in preventing OASIS.
authors.affiliation: Department of Obstetrics and Department of Gynecology, Oslo University Hospital, Oslo, Norway.|Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Kathrine
authors.identifier: http://orcid.org/0000-0002-8444-8819
authors.initials: K
authors.lastname: Fodstad
authors.affiliation: Department of Obstetrics and Department of Gynecology, Oslo University Hospital, Oslo, Norway.|Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Anne C
authors.identifier: http://orcid.org/0000-0001-9247-5721
authors.initials: AC
authors.lastname: Staff
authors.affiliation: Department of Obstetrics and Department of Gynecology, Oslo University Hospital, Oslo, Norway.
authors.forename: Katariina
authors.identifier: http://orcid.org/0000-0001-9970-8401
authors.initials: K
authors.lastname: Laine
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries; D001291:Attitude of Health Personnel; D004841:Episiotomy / Q000009:adverse effects / Q000145:classification / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005831:Genital Diseases, Female / Q000209:etiology / Q000517:prevention & control; D019538:Health Care Surveys; D006801:Humans; D020380:Needs Assessment; D007744:Obstetric Labor Complications / Q000209:etiology / Q000517:prevention & control; D009774:Obstetrics / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D012537:Scandinavian and Nordic Countries
keywords: Episiotomy; episiotomy technique; incision angle; lateral episiotomy; manual perineal support; mediolateral episiotomy; obstetric anal sphincter injury