Evaluation of Accuracy of Episiotomy Incision in a Governmental Maternity Unit in Palestine: An Observational Study
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 un...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-01-01
|
| Series: | Obstetrics and Gynecology International |
| Online Access: | http://dx.doi.org/10.1155/2018/6345497 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850214986912104448 |
|---|---|
| author | 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 |
| author_facet | 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 |
| author_sort | Hadil Y. Ali-Masri |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-7f70de123dea45f4b2f86779775bb719 |
| institution | OA Journals |
| issn | 1687-9589 1687-9597 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Obstetrics and Gynecology International |
| spelling | doaj-art-7f70de123dea45f4b2f86779775bb7192025-08-20T02:08:45ZengWileyObstetrics and Gynecology International1687-95891687-95972018-01-01201810.1155/2018/63454976345497Evaluation of Accuracy of Episiotomy Incision in a Governmental Maternity Unit in Palestine: An Observational StudyHadil Y. Ali-Masri0Sahar J. Hassan1Kaled M. Zimmo2Mohammed W. Zimmo3Khaled M. K. Ismail4Erik Fosse5Hasan Alsalman6Åse Vikanes7Katariina Laine8Department of Obstetrics, Palestine Medical Complex, Ramallah, State of PalestineFaculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit Box14, Ramallah, State of PalestineThe Intervention Centre, Oslo University Hospital, Rikshospitalet, 4950 Nydalen, 0424 Oslo, NorwayThe Intervention Centre, Oslo University Hospital, Rikshospitalet, 4950 Nydalen, 0424 Oslo, NorwayDepartment of Obstetrics and Gynaecology, Faculty of Medicine, Ain Shams University, Cairo, EgyptThe Intervention Centre, Oslo University Hospital, Rikshospitalet, 4950 Nydalen, 0424 Oslo, NorwayDepartment of Obstetrics, Palestine Medical Complex, Ramallah, State of PalestineThe Intervention Centre, Oslo University Hospital, Rikshospitalet, 4950 Nydalen, 0424 Oslo, NorwayDepartment of Obstetrics, Oslo University Hospital, Ullevål, 0424 Oslo, NorwayEpisiotomy 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.http://dx.doi.org/10.1155/2018/6345497 |
| spellingShingle | 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 Evaluation of Accuracy of Episiotomy Incision in a Governmental Maternity Unit in Palestine: An Observational Study Obstetrics and Gynecology International |
| title | Evaluation of Accuracy of Episiotomy Incision in a Governmental Maternity Unit in Palestine: An Observational Study |
| title_full | Evaluation of Accuracy of Episiotomy Incision in a Governmental Maternity Unit in Palestine: An Observational Study |
| title_fullStr | Evaluation of Accuracy of Episiotomy Incision in a Governmental Maternity Unit in Palestine: An Observational Study |
| title_full_unstemmed | Evaluation of Accuracy of Episiotomy Incision in a Governmental Maternity Unit in Palestine: An Observational Study |
| title_short | Evaluation of Accuracy of Episiotomy Incision in a Governmental Maternity Unit in Palestine: An Observational Study |
| title_sort | evaluation of accuracy of episiotomy incision in a governmental maternity unit in palestine an observational study |
| url | http://dx.doi.org/10.1155/2018/6345497 |
| work_keys_str_mv | AT hadilyalimasri evaluationofaccuracyofepisiotomyincisioninagovernmentalmaternityunitinpalestineanobservationalstudy AT saharjhassan evaluationofaccuracyofepisiotomyincisioninagovernmentalmaternityunitinpalestineanobservationalstudy AT kaledmzimmo evaluationofaccuracyofepisiotomyincisioninagovernmentalmaternityunitinpalestineanobservationalstudy AT mohammedwzimmo evaluationofaccuracyofepisiotomyincisioninagovernmentalmaternityunitinpalestineanobservationalstudy AT khaledmkismail evaluationofaccuracyofepisiotomyincisioninagovernmentalmaternityunitinpalestineanobservationalstudy AT erikfosse evaluationofaccuracyofepisiotomyincisioninagovernmentalmaternityunitinpalestineanobservationalstudy AT hasanalsalman evaluationofaccuracyofepisiotomyincisioninagovernmentalmaternityunitinpalestineanobservationalstudy AT asevikanes evaluationofaccuracyofepisiotomyincisioninagovernmentalmaternityunitinpalestineanobservationalstudy AT katariinalaine evaluationofaccuracyofepisiotomyincisioninagovernmentalmaternityunitinpalestineanobservationalstudy |