Okeahialam Nicola Adanna, Sultan Abdul H
Croydon University Hospital, 530 London Rd, Thornton Heath, CR7 7YE UK.
St George's University of London, London, UK.
J Obstet Gynaecol India. 2024 Jun;74(3):214-218. doi: 10.1007/s13224-023-01871-8. Epub 2023 Nov 28.
A mediolateral episiotomy is recommended when indicated at a 60° angle at crowning, to avoid obstetric anal sphincter injuries (OASIs) by episiotomies angled too close or distant to the anus. This study surveyed obstetricians in India regarding the recommended episiotomy angle and their ability to correctly draw the angle.
Workshops were conducted in India to share knowledge in the prevention and repair of OASIs. A questionnaire was distributed prior to the workshop. Participants were asked to describe the recommended episiotomy angle and to draw this on a paper replica of the perineum. The intra-class correlation coefficient (ICC) was calculated to assess the inter-rater reliability between the angle stated and drawn. A 2° difference was deemed acceptable. Standard errors of measurement (SEM) were calculated to measure the range of error of each measurement.
One hundred and forty doctors participated. 47.9% described the angle of an episiotomy to be 60°. Only 2.2% drew an angle of 60°, but 8.7% ( = 12) drew between 58 and 62°. Only 5.8% ( = 6) of doctors correctly drew the episiotomy angle they described. There was poor agreement ICC = 0.18 (- 0.01 to 0.36) with a SEM of ± 12.2°.
Knowledge surrounding the recommended episiotomy angle is lacking. Doctors are failing to estimate their desired episiotomy angle. This highlights the need for national guidelines, the creation and validation of structured training programmes to improve accuracy, or using fixed-angle devices such as the EPISCISSORS-60 or other proven measurement aids to minimise preventable harm due to human error.
当胎头着冠时需行会阴侧切术，推荐以60°角进行，以避免因侧切角度距肛门过近或过远而导致产科肛门括约肌损伤（OASIs）。本研究针对印度产科医生对推荐侧切角度的认知以及正确画出该角度的能力进行了调查。
在印度举办了研讨会，以分享产科肛门括约肌损伤的预防和修复知识。在研讨会前分发了问卷。要求参与者描述推荐的会阴侧切角度，并在会阴的纸质复制品上画出该角度。计算组内相关系数（ICC）以评估所述角度和所画角度之间的评分者间信度。2°的差异被认为是可接受的。计算测量标准误差（SEM）以测量每次测量的误差范围。
140名医生参与了研究。47.9%的人描述侧切角度为60°。只有2.2%的人画出了60°的角度，但8.7%（n = 12）画出的角度在58°至62°之间。只有5.8%（n = 6）的医生正确画出了他们所描述的侧切角度。一致性较差，ICC = 0.18（-0.01至0.36），SEM为±12.2°。
缺乏关于推荐侧切角度的知识。医生无法准确估计他们期望的侧切角度。这凸显了制定国家指南、创建和验证结构化培训计划以提高准确性的必要性，或者使用诸如EPISCISSORS-60之类的固定角度装置或其他经过验证的测量辅助工具，以尽量减少人为错误导致的可预防伤害。
