Evaluation of accuracy of mediolateral episiotomy incisions using a training model. Issue 1 (January 2015)

• Record Type: Journal Article
• Authors: Silf, K.; Woodhead, N.; Kelly, J.; Fryer, A.; Kettle, C.; Ismail, K.M.K.
• Is Part Of: Midwifery. Volume 31:Issue 1(2015)
• Page Start: 197
• Page End: 200
• Publication Date: 2015-01
• Subjects: Episiotomy -- Perineum -- Midwifery -- Obstetrics -- Childbirth; Midwifery -- Periodicals; Midwifery -- Periodicals; Sages-femmes -- Périodiques; Midwifery; Periodicals; Electronic journals; 618.2005
• DOI: 10.1016/j.midw.2014.08.009
• Languages: English
• ISSNs: 0266-6138

Abstract

Abstract: Background: Episiotomy is one of the most commonly performed surgical procedures worldwide. In the UK the use of episiotomy is selective, rather than routine, and a right mediolateral episiotomy (RMLE) is considered standard practice. According to The National Institute of Health and Care Excellence (NICE, 2007 ) guideline for intrapartum care such an episiotomy should be cut at an angle between 45° and 60° to the vertical axis. Recent evidence suggests that the angle of incision of mediolateral episiotomy (MLE) is associated with risk of obstetric anal sphincter injury (OASIS). Objective: to assess the accuracy of individual practitioner׳s techniques when performing a RMLE. Design: an audit of practice against nationally set standards. Setting: at a national midwifery conference and prior to three multiprofessional perineal repair training workshops in the West Midlands region of the UK. Participants: 144 midwives and 53 obstetric trainees. Measurements: practitioners were asked to perform a RMLE incision on a bespoke training model, which is designed to give a realistic representation of a stretched perineum at crowning of the baby׳s head. Four parameters were measured: (1) distance of the starting point from the midline; (2) angle subtended to the perpendicular; (3) length and (4) shape of the incision (curved, straight or J-shaped). Findings: of the 197 incisions performed only 12.7% (14.6%, n =21/144 of midwives and 7.5%, n =4/53 of obstetricians) complied with the defined technique of a RMLE for correctness of angle and placement. A 2-sided Fisher׳s exact test showed no significant difference between previous attendance at perineal management training and incision accuracy. Highlights: We audit the accuracy of right mediolateral episiotomy incisions performed on a training model. Only a minority of clinicians performed a correct mediolateral episiotomy with correct angle and placement. There was no correlation between previous training and accuracy of incision. Practitioners should receive practical training on technique of performing a correct mediolateral episiotomy.