Are we perfrming episiotomies correctly? A study to evaluate french technique in a hight-risk maternity unit
IUGA Academy. BECHARD F. Jun 30, 2018; 212813; 383

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Are we performing episiotomies correctly? A study to evaluate french technique in a hight-risk maternity unit

Bechard, F1; Geronimi, J2; Vieille, P3; Letouzey, V1; DeTayrac, R1

1: Carémeau University Hospital; 2: Biostatistician, PhD Cedric, CNAM; 3: Perpignan Hospital

Introduction: The aim of this study was to evaluate episiotomy technique, in particular suture angles, and any correlation between suture angle and severe perineal tearing.

Material and Methods: An observational questionnaire-based study was conducted between 01 August 2015 and 30 April 2016 among accoucheurs performing episiotomies in a French maternity unit with facilities for high-risk pregnancies. For each patient included, accoucheurs were asked to measure the episiotomy suture angle, and to record the angle at which they thought they had cut, the length of the episiotomy, its distance from the anus, and whether the woman sustained a sphincter injury.

Results: The centre’s episiotomy rate during the study period was 15%. We analysed the characteristics of episiotomies performed on 88women (68by doctors and 20by midwives). Only 43% of suture angles were between 45° and 60° (45.6% of those performed by doctors vs 38.1% by midwives, p=0.8623), whereas 91% of accoucheurs thought they had cut within the correct range. Doctors made longer incisions than midwives (4cm[4.2–5.0] vs 3cm[2.5–3.5], p=0.0006). Only 40.5% of accoucheurs correctly estimated the incision angle. Twelve (13.64%) of the 88women sustained a third-degree perineal tear. The risk of sphincter injury was higher with suture angles <45° (odds ratio 5.46 [1.11–26.75], p=0.037). After multivariate analysis, this result was no longer significant (p=0.079).

Conclusion: It appears that many accoucheurs have difficulty estimating episiotomy incision angles correctly and that education and training in this domain requires improvement.


Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Boston Scientific, Coloplast).

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