Cutting a mediolateral episiotomy at the correct angle: evaluation of a new device, the Episcissors-60.

BACKGROUND: Anal incontinence is nine times more prevalent in women than in men due to obstetric anal sphincter injury (OASI). OASI is linked to midline episiotomies and mediolateral episiotomies with post-delivery angles of <30 and >60 degrees. Studies show that doctors and midwives are unable to correctly "eyeball" the safe angle required due to perineal stretching by the fetal head at crowning. A new scissor instrument (Episcissors-60) was devised to allow cutting a mediolateral episiotomy at a fixed angle of 60 degrees from the perineal midline. METHODS: Scissors with a marker guide limb pointing towards the anus were devised, ensuring an angle of 60 degrees between the scissor blades and the guide limb. This device was initially tested in models. Post-delivery angles were recorded on transparencies and analyzed by an author blinded to clinical details. Accoucheurs were asked to rate the ease of use on a 5-point scale. RESULTS: Of the 17 women, 14 delivered with ventouse, two with forceps, and one with sequential ventouse-forceps. Indications for instrumental delivery were suboptimal cardiotocogram and/or prolonged second stage of labor. Mean birth weight was 3.41 (2.92-4.12) kg. A mean post-delivery angle of 42.4±7 (range 30-60, median 43) degrees (95% confidence interval 38.8-46) was achieved with the Episcissors-60 instrument. Eighty-eight percent of clinicians agreed or strongly agreed that the scissors were easy to use. CONCLUSION: The Episcissors-60 delivered a consistent post-delivery angle of 43 degrees. They could replace "eyeballing" when performing mediolateral episiotomies and form part of a preventative strategy to reduce OASI.

Vaginal algometer: development and application of a device to monitor vaginal wall pressure pain threshold.

We describe a device (which we have named a vaginal algometer) which can measure the pressure pain threshold (PPT) on the lateral walls of the vagina. The device was assessed in 63 healthy women and a normal range for this measurement was established. Each woman had her vaginal wall PPT measured and was asked about the acceptability of the procedure. We demonstrate that the vaginal algometer can provide a quantitative assessment of vaginal PPT and that the procedure is acceptable to most women.