|Optimization of Safe Zone Suture Angle in Mediolateral Episiotomy Using Triangular Set Square|
|Nasim Shokouhi, Elham Shirali, Mahbod Ebrahimi, Nafiseh Saedi, Elham Feizabad|
|Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran|
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Keywords : Obstetric anal sphincter injury, Normal vaginal delivery, Suture angle, EPICSISSOR-60
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Objectives: Episiotomy is a surgical intervention to decrease the risk of obstetric anal sphincter injuries (OASIs) that adversely affect normal vaginal delivery (NVD). However, the intervention itself may lead to significant perineal laceration and postpartum anal incontinence. This research aimed to compare the suture angle and postpartum anal incontinence of mediolateral episiotomy aided with a 60-degree triangular set square (TRSS-60) with those of a routine mediolateral episiotomy.
Materials and Methods: This prospective study was performed on primiparous pregnant women with NVD requiring episiotomy in Yas hospital from April 2020 to November 2020. The subjects were assigned to control and intervention groups at a 1:1 ratio. Outcome measures included suture angle and Wexner fecal incontinence scores between the groups.
Results: Forty primiparous women have enrolled in the study. The average perineal body length was 3.64 ± 0.54 cm at the first stage of labor and 4.86 ± 0.71 cm during crowning. The mean suture angle varied significantly (P < 0.001) between the intervention and control groups (48.5 vs. 33.7). The suture angle of all participants in TRSS-60 was higher than 40°. Wexner score assessment revealed that the most frequent complaint was gas incontinence in postpartum women (four in the control group and one in the intervention group).
Conclusions: This study suggests that TRSS-60 could be used as an affordable, highly accessible, inexpensive, and effective approach to reach the safe zone angles during episiotomies, reduce OASIs, and supply an appropriate replacement for EPICSISSOR-60 in low-resource areas.
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