Geburtshilfe Frauenheilkd 2016; 76 - P20
DOI: 10.1055/s-0036-1583793

Comparison of Obstetric anal sphincter injuries (OASIS) in nulliparous women before and after introduction of the EPISCISSORS-60® at two Hospitals in the United Kingdom

Y van Roon 1, C Kirwin 2, N Rahman 3, L Vinayakarao 2, L Melson 2, N Kester 1, S Pathak 1, A Pradhan 1
  • 1Abteilung für Geburtshilfe und Gynäkologie, Hinchingbrooke Hospital, Huntingdon, UK
  • 2Abteilung für Geburtshilfe und Gynäkologie, Poole Hospital, Poole, UK
  • 3Abteilung für Geburtshilfe und Gynäkologie, Addenbrookes Hospital, Cambridge, UK


To assess whether the introduction of the EPISCISSORS-60®, episiotomy scissors specially designed to achieve a cutting angle of 40 – 60 °, would result in a reduction in obstetric anal sphincter injuries (OASIS) in nulliparous women.


OASIS in the UK has tripled between 2000 – 2012. For an episiotomy to be effective in reducing OASIS it needs to be cut at 60 °. Only 22% of doctors and no midwife cut episiotomies at this angle. The EPISCISSORS-60® are designed to achieve a 60 °episiotomy angle at all times. The EPISCISSORS-60® were introduced in 2 hospitals in the UK and we present the data collected over 3 months with regards to episiotomy angles, user satisfaction and OASIS.


A structured training programme for all doctors and midwifes was used to introduce the scissors. The decision to perform an episiotomy stayed with the operator. Data with regards to post suturing angles, user feedback, episiotomy use and incidence of OASIS was collected both through specifically designed forms and through the hospital data collection system.


There were a total of 829 nulliparous vaginal deliveries. Post suturing episiotomy angles were recorded for 100 nulliparous vaginal deliveries. Average post suturing episiotomy angles were 53 °(SD = 6.5, 95% CI = 50.7 – 55.8) in spontaneous vaginal deliveries (SVD) and 52 ° (SD = 9.6, 95% CI = 49 – 54) in operative vaginal deliveries (OVD). The Episcissors-60® were rated as 'good' to 'very good' by 84% of users. Overall, there was an 18% OASIS reduction (p = 0.22). There was 85% reduction in OASIS in nulliparous SVDs given episiotomy (1%) compared to those not given episiotomy (6.9%) in 2015 (p = 0.01).


Using the EPISCISSORS-60® the majority of healthcare professionals achieve the recommended post suturing episiotomy angles between 40 and 60 °. There has been statistically significant reduction in OASIS in nulliparous spontaneous vaginal deliveries and a clinically significant reduction in OASIS in nulliparous operative deliveries.