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PL.48 Do We Perform Mediolateral Episiotomy at the Optimum Angle?

Introduction Dr Foster reported obstetric anal sphincter injuries (OASIS) incidence in Norwich as 3.72% for spontaneous vaginal deliveries and 10.76% for instrumental deliveries against expected incidence of 3.6% and 7.6% respectively. The Norfolk and Norwich Improving Patient Safety (NNIPS) programme supported an OASIS reduction project. One factor thought important in OASIS is the angle of mediolateral episiotomy; larger angles are associated with a lower incidence (Eogan et al, 2005). Study Aim To measure episiotomy angles to confirm optimal episiotomy angle of > 45° from midline. Setting A large UK university teaching hospital delivering 6000 babies annually. Cohort Women with episiotomy delivered in June to July 2011. Methods Two independent measurements were taken before discharge from the postnatal ward using acetate paper placed over the perineum and the angle traced on the paper measured from anus (6 O’clock) to the episiotomy – mean angle was calculated for each patient. Results Twenty nine women agreed to measurement - 14 were delivered by forceps, 4 by ventouse and 11 had spontaneous vaginal deliveries. 21/29 (72%) had episiotomy angles < 45° compared with 8/21 (28%) who had angles > 45°. We found no OASIS in this cohort. Conclusion We were not performing episiotomies at the optimum angle. We implemented: An education campaign for maternity health professionals, using the slogan “Straight at 8” meaning cut towards 8 O’clock. Sharpening of episiotomy scissors as bluntness was identified by staff as an important issue.