Comparison of obstetric anal sphincter injuries in nulliparous women before and after introduction of the EPISCISSORS-60^® at two hospitals in the United Kingdom

Figures & data

Table 1 Overview for 2014 and 2015 of total births, first births, episiotomy rates, and obstetric anal sphincter injuries (OASIS) rates for both spontaneous vaginal deliveries (SVDs) and operative vaginal deliveries (OVDs) in nulliparous (NP) women

	Hinchingbrooke 2014	Hinchingbrooke 2015	Poole 2014	Poole 2015	Combined 2014	Combined 2015
Total births	2,342	633	4,972	1,947	7,314	2,580
All first births	991/2,342 (42.3%)	273 (43.1%)	2,165 (43.5%)	885 (45.4%)	3,156	1,158
NP (SVD + OVD)	726	197	1,512	641	2,238	838
OASIS in NP (SVD + OVD)	52/726 (7.1%)	12/197 (6%); 14% reduction	107/1,512 (7%)	37/641 (5.7%); 19% reduction	159/2,238 (7.1%)	49/838 (5.8%); 18% reduction; P=0.22
OASIS in all NP	52/991 (5.2%)	12/273 (4.4%); 15.4% reduction; P=0.6	107/2,165 (4.9%)	37/885 (4.2%); 16% reduction; P=0.4	159/3,156 (5%)	49/1,158 (4.2%); 16% reduction; P=0.2
Episiotomies in all NP	289/991 (29.1%)	83/273 (30%); ns	503/2,165 (23%)	238/885 (26.8%)	792/3,156 (25%)	321/1,158 (27.7%); 10.8% increase; P=0.08
Episiotomies in NP (SVD + OVD)	289/726 (39.8%)	83/197 (42.1%)	503/1,512 (33.3%)	238/641 (37.1%)	792/2,238 (35.3%)	321/838 (38.3%); 8.5% increase; P=0.14
OVD in NP	239/991 (24%)	60/273 (30.4%)	428/2,165 (19.7%)	189/885 (21.3%)	667/3,156 (21.1%)	249/838 (29.7%)
Episiotomies in OVD in NP	203/239 (85%)	59/60 (99%); 16.5% increase; ***P=0.003	380/428 (89%)	164/189 (87%)	583/667 (87.4%)	223/249 (89.5%)
OASIS in OVD in NP	18/239 (7.53%)	4/60 (6.66%); 12% reduction; ns	26/428 (6.07%)	10/189 (5.29%); 12.8% reduction; P=0.85	44/667 (6.5%)	14/249 (5.6%); 13.8% reduction; P=0.065
OASIS in NP OVDs given episiotomies	12/203 (5.9%)	3/59 (5%); 15% reduction; P=1	25/380 (6.6%)	9/164 (5.5%); 16.7% reduction; P=0.7	37/583 (6.3%)	12/223 (5.4%); 14.2% reduction; P=0.7; RR=1.18
OASIS in NP OVDs not given episiotomies	6/36 (16.7%)	1/1 (100%)	1/48 (2%)	1/25 (4%)
SVD in NP	487	137	1,084	452	1,571	589
OASIS in SVD in NP	34 (7%)	8 (5.8%); 17% reduction	81 (7.47%)	27 (5.97%); 20% reduction; P=0.32	115/1,571 (7.3%)	35/589 (5.9%); 19% reduction in OASIS
OASIS in NP SVDs without episiotomy	31/401 (7.7%)	8/113 (7%); 9% reduction	70/962 (7.27%)	26/378 (6.87%); 5.5% reduction; ns	101/1,363 (7.4%)	34/491 (6.9%)
Episiotomies in NP SVDs	86/487 (17.7%)	24/137 (17.5%)	122/1,084 (11.1%)	74/452 (16.37%); 47% increase; ***P=0.007	208/1,571 (13.2%)	98/589 (16.6%), 26% increase; ***P=0.04
OASIS in NP SVDs given episiotomies	2/86 (2.3%)	0/24 (0%); 100% reduction; P=1	11/122 (9%)	1/74 (1.35%); 85% reduction; ***P=0.03	13/208 (6.25%)	1/98 (1%); 84% reduction; P=0.04

Notes: All P-values calculated by Fisher’s exact two-tailed test (GraphPad software, Inc., La Jolla, CA, USA). Bold values represent significant results.

Abbreviations: RR, risk ratio; ns, not significant.

Figure 1 PBL distribution.

Abbreviations: PBL, perineal body length; SVD, spontaneous vaginal delivery; OVD, operative vaginal delivery.

Figure 2 Distribution of post-suture episiotomy angles.

Figure 3 User feedback 1–5 (poor–very good), n=76.

Figure 4 Significant changes in episiotomy numbers.

Abbreviations: SVD, spontaneous vaginal delivery; OVD, operative vaginal delivery; VD, vaginal delivery.

Figure 5 Incidence of OASIS before/after the introduction of EPISCISSORS-60^®.

Abbreviations: OASIS, obstetric anal sphincter injuries; OVD, operative vaginal delivery; SVD, spontaneous vaginal delivery; VD, vaginal delivery.

Figure 6 Obstetric anal sphincter injuries (OASIS) in spontaneous vaginal delivery (SVD): episiotomy versus no episiotomy.