European Journal of Molecular & Clinical Medicine

Abstract

Introduction: Episiotomy angle is a crucial factor in causation of obstetric anal sphincter injuries (OASIS), which are the major cause of female bowel incontinence. Sutured episiotomies angled too close to the midline fail to unload the perineum sufficiently and predispose to OASIS. We compared the occurrence of OASIS with traditional mediolateral episiotomy given by visual assessment of 450 with those of fixed angle 600.
Materials and Methods: A prospective cluster based randomized trial was conducted in 401 women, 200 in A and 201in B group. Group A were given traditional mediolateral episiotomy by visual assessment. Group B were given fixed angle 600 by measurement using either aluminium foil or Episcissors-60. Post-delivery, severe perineal tears were assessed. After suturing the episiotomy, angles, length of episiotomy and postdelivery linear distance from caudal end of the sutured episiotomy to the anus were measured with protractors and rulers in both groups and were statistically analysed.
Results: Group B had lesser incidence of OASIS (7%) compared to Group A (3%) which was not statistically significant. There was statistically significant difference in the suture angles (28.80 in Group A versus 31.780 in Group B), length of episiotomy (2.98 cm in Group A versus 3.09 cm in Group B) and linear distance from caudal end of the sutured episiotomy to the anus (2.97 cm in Group A versus 3.13 cm in Group B).
Conclusion: The sutured episiotomies in Group B are farther away from the midline in angular and distance measures, and are longer when compared to those of Group A, hence at lower OASIS risk.