Obstetric anal sphincter injury events prior and after Episcissors-60 implementation: A systematic review and meta-analysis

Abstract

Objective: To assess the effect of Episcissors-60 upon obstetric anal sphincter injuries (OASIS) reduction in nulliparous women.

Study design: Independent literature search for relevant studies was performed up to 30th May 2021 on five databases: Embase (OVID), MEDLINE (R) (OVID), CAB Abstracts (OVID), ClinicalTrials.gov, and Google Scholar. The primary outcome was to assess OASIS events prior and after Epi-60 implementation in clinical practice in natural births (NB), whilst secondary outcomes included overall operative vaginal delivery (OVD) %/spontaneous vaginal deliveries (SVD) % deliveries, episiotomy rates and operator satisfaction. All included studies (retrospective, prospective and time-series) examined the effect of Episcissors-60 implementation upon observed OASIS %.

Results: A total of 14,027 nulliparous females were included in the meta-analysis. Overall, study heterogeneity was high at I²: 79% with collectively fair quality of studies, as assessed by the Newcastle-Ottawa scale. Overall, this analysis highlights significant differences of OASIS events that might suggest their implementation as standard practice [RD -0.02, 95% CI -0.03 to 0.00; P = 0.03].

Conclusion: The present analysis highlights significant differences of OASIS events pre- and post- Epi-60, that may suggest Episcissors-60 implementation as standard practice. Nonetheless, to ensure data integrity, well reported observational studies and robust randomized controlled trials (RCTs) are required prior to introduction of Epi-60 as standard episiotomy technique in clinical practice.

Keywords: Episcissors-60; Episiotomy; Obstetric anal sphincter injuries; Operative vaginal delivery; Spontaneous vaginal delivery.