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Episcissors‑60 for mediolateral episiotomy

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1 Recommendations

1.1 Episcissors‑60 show promise for mediolateral episiotomy. But there is currently not enough evidence to fully support the case for routine adoption in the NHS.

1.2 Research is recommended to address uncertainties about the efficacy and safety of using Episcissors‑60. This research should:

  • determine if using single-use disposable Episcissors‑60 in addition to other care bundle measures is more effective in achieving an optimal episiotomy angle and in preventing episiotomy-related obstetric anal sphincter injuries (OASI) than standard episiotomy scissors

  • include patient-reported outcome measures

  • address potential equality considerations by ensuring patients at greatest risk of OASI are recruited

  • determine the relative cost of using single-use disposable Episcissors‑60 compared with standard episiotomy scissors.

Why the committee made these recommendations

Episcissors‑60 are adapted surgical scissors. They are used to guide and make a cut between the vagina and anus (episiotomy) at an optimal angle (45 to 60 degrees to the midline, according to NICE's guideline on intrapartum care) during delivery. This is called a guided mediolateral episiotomy.

Cutting at the optimal angle is important to reduce the chance of OASI, which can have severe long-term effects, such as faecal incontinence.

There is not much good evidence that Episcissors‑60 are better than standard scissors, when used with other best practice care measures to prevent OASI (such as the Royal College of Obstetricians and Gynaecologists OASI care bundle). Also, the evidence that is available is only in reusable Episcissors‑60, rather than the single-use disposable Episcissors‑60, which are now the only ones available. The published evidence and expert advice suggest that single-use disposable Episcissors‑60 could be promising, and further research into their potential advantages is recommended.