Highlights
- •Significant differences of OASIS events pre- and post- Episcissors-60 favour the use of Episcissors-60.
- •Further observational and randomised controlled studies are required to inform the Episcissors-60 integration in standard clinical practice.
- •Operator experience and fetomaternal parameters should be controlled for in future studies to reach meaningful clinical conclusions.
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
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Article info
Publication history
Published online: September 01, 2021
Accepted:
August 25,
2021
Received:
June 18,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
