1 Recommendations

1 Recommendations

1.1 Episcissors‑60 show promise for mediolateral episiotomy. But there is currently not enough evidence to 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 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 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.

Because not much good evidence is available, it is recommended that new studies are done to determine with more certainty whether 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).

  • National Institute for Health and Care Excellence (NICE)