Naidu Madhu, Kapoor Dharmesh S, Evans Sarah, Vinayakarao Latha, Thakar Ranee, Sultan Abdul H
Croydon University Hospital, 530, London Road, Croydon, CR7 7YE, UK.
Int Urogynecol J. 2015 Jun;26(6):813-6. doi: 10.1007/s00192-015-2625-9. Epub 2015 Feb 6.
Episiotomy is regarded as the most common maternal obstetric surgical procedure. It is associated with a significant increase in blood loss, lower pelvic floor muscle strength, dyspareunia, and perineal pain compared with a perineal tear. We tested the hypothesis that all doctors and midwives can perform an episiotomy when prompted to, specifically cut at 60° from the midline (in a simulation model).
Doctors and midwives attending the BMFMS Annual Meeting (2014), Croydon Perineal Trauma Course and staff at Poole General Hospital were invited to cut a paper replica of the perineum with a commonly used episiotomy incision pad. Participants were prompted to cut an episiotomy at 60° to the perineal midline with the anus as a reference point. The angles and distances were measured using protractors and rulers. A 58-62° band was deemed acceptable to account for measurement errors.
A total of 106 delegates participated. Only 15 % of doctors and midwives cut an episiotomy between 58 and 62°. Over one third (36 %) cut the episiotomy between 55 and 65° (inclusive). Nearly two thirds either underestimated the angle (<55°; 44 %), or overestimated the angle (>66°; 18 %). Thirty-six and 7.5 % of episiotomies were cut at <50 and >70° respectively. The origination point of the episiotomy was 5 mm away from the midline (IQR 1-8 mm).
This original observational study shows that doctors and midwives were poor at cutting at the prompted episiotomy angle of 60°. This highlights the need to develop structured training programmes to improve the visual accuracy of estimating angles or the use of fixed angle devices to help improve the ability to estimate the desired angle.
会阴切开术被视为最常见的产妇产科外科手术。与会阴撕裂相比，它会导致失血量显著增加、盆底肌肉力量下降、性交困难和会阴疼痛。我们检验了这样一个假设：所有医生和助产士在接到提示时都能进行会阴切开术，具体而言是在模拟模型中从中线处以60°角进行切割。
邀请参加2014年BMFMS年会、克罗伊登会阴创伤课程的医生和助产士以及普尔总医院的工作人员，使用常用的会阴切开术切口垫切割会阴的纸质复制品。以肛门为参考点，提示参与者以60°角与会阴中线进行会阴切开术。使用量角器和尺子测量角度和距离。考虑到测量误差，58 - 62°的范围被视为可接受。
共有106名代表参与。只有15%的医生和助产士切割的会阴切开术角度在58至62°之间。超过三分之一（36%）的人切割的会阴切开术角度在55至65°之间（含两端）。近三分之二的人要么低估了角度（<55°；44%），要么高估了角度（>66°；18%）。分别有36%和7.5% 的会阴切开术角度切割在<50°和>70°。会阴切开术的起始点距离中线5毫米（四分位距1 - 8毫米）。
这项原创性观察研究表明，医生和助产士在按照提示的60°角进行会阴切开术时表现不佳。这凸显了制定结构化培训计划以提高估计角度的视觉准确性或使用固定角度装置来帮助提高估计所需角度能力的必要性。
