Delivery In Nulliparous Women Research Articles

MRI-based pelvimetric measurements as predictors for a successful vaginal breech delivery in the Frankfurt Breech at term cohort (FRABAT)

ObjectivesThe purpose of this study was to investigate the role of the maternal pelvis, assessed by MRI pelvimetry in nulliparous women expecting a term fetus in breech presentation, to predict a successful and safe vaginal birth. Study designIn this monocentric and anonymized cohort study, we enrolled 367 nulliparous women with breech presentation at 39+0 to 41+0 weeks of gestation during a period of 8 years at the University Women's Hospital in Frankfurt/Main. Pelvic measurements were obtained by standard MRI imaging. We correlated the obstetric conjugate, the pubic angle and the distance between the ischial tuberosities (intertuberous distance) with the maternal and fetal outcomes of vaginally intended breech births. The data was evaluated using logistic regression analysis. Results241 of 367 participants (65.7%) experienced a successful vaginal delivery whereas 126 patients (34.3%) were subjected to secondary cesarean section. An increasing obstetric conjugate was significantly associated with an increasing rate of successful vaginal deliveries. No significant correlation of the intertuberous distance and the pubic angle with the mode of delivery could be shown. Although statistically not significant, we were able to define cut-off values of 10.9 cm in the intertuberous distance and 70° in the pubic angle; below these values, no successful vaginal delivery was recorded. No significant differences in the short-term outcomes were seen between the neonates of the vaginal delivery and the cesarean section groups. Inter- and intraobserver variability showed excellent reproducibility for all MRI parameters. ConclusionThe obstetric conjugate correlates with the rate of vaginal deliveries in nulliparous women at term and can be used as a useful criterion for pre-selection and counseling of women with breech presentation and the desire for a vaginal delivery.

The Influence of Fetal Head Circumference and Fetal Weight Measurement Assessed By Intrapartum Ultrasound on Labor Outcome

Background: labor is a clinical diagnosis characterized by regular, painful uterine that increase in frequency and intensity is associated with progressive cervical effacement or dilatation. More specifically, it is associated with a change in the myometrial contractility pattern from irregular contractures (long-lasting, low-frequency activity) to regular contractions (high-intensity, high frequency activity). Aim of the work: it was to determine if fetal head circumference and fetal weight could predict the rate of caesarian section and operative vaginal deliveries in nulliparous women in labor. Patients and Methods: this study was carried out at Al Alamein Hospital from January 2017 to January 2018 on two hundred (200) primigravida women; their ages ranged from 20 to 30 years and the gestational ages ranged from 38-40 weeks with normal singleton pregnancy with cephalic presentation in labor. Results: there were highly statistically significant relations between mode of delivery and fetal head circumference and estimated fetal weight as p value (0.001).it was found that large fetal head circumference relative to maternal pelvic diameter is the main cause of prolonged labor and therefor increased risk of primary caesarian section. Conclusion: the numerical data have a significant relation between intra partum head circumference and fetal weight and the incidence of primary caesarian section, maternal and fetal complications. Recommendations: according to numerical results obtained from this study. The study recommends strict labor monitoring by partogram in cases where fetal head circumference is more than 35cm or fetal weight is more than 3950gms.

Effect of Group Counseling on the Type of Delivery in Nulliparous Women: A Randomized Controlled Trial

Effect of Group Counseling on the Type of Delivery in Nulliparous Women: A Randomized Controlled Trial

Delivery of Nulliparous Women at Term with Vaginismus [15C

INTRODUCTION: To compare the mode of delivery of nulliparous women with vaginismus at term to those without vaginismus. METHODS: This was a retrospective case-control study. Nulliparous women ≥37 weeks presenting in labor with a diagnosis of vaginismus, defined as chronic recurring difficulty for a woman to allow vaginal penetration, were included. The control group consisted of the next two nulliparous women delivering at term. Delivery data were compared between the groups. RESULTS: 26 women with vaginismus were compared to 52 controls. Demographics were similar between the groups. The cesarean delivery rate was significantly higher in the vaginismus group (38% vs. 13%, p=0.019). Maternal request was the major contributing factor (19% vs. 0%, p=0.002). Four women in the vaginismus group required perineal suturing using IV sedation or general anesthesia compared to none in the control group. CONCLUSION: Nulliparous women with vaginismus have a significantly higher cesarean delivery rate. Maternal request is a major contributing factor rather than standard obstetrical indications. Perineal repair following vaginal delivery often requires iv sedation in the operating room.

Physical activities (exercises or choreses) during pregnancy and mode of delivery in nulliparous women: A prospective cohort study

ObjectiveThe aim of this study was to investigate changes in physical activities during pregnancy and the relationship between physical activity and unplanned caesarean sections (CSs). Materials and methodsA cohort study design was carried out. A cohort of 2029 pregnant women was established when they received prenatal care at 18–22 weeks of gestation in a medical center in southwest Iran. Participants were asked to recall their levels of physical activity during pre-pregnancy. The data were processed using Statistics/Data Analysis. To compare activities the chi-square was used to identify significant differences between the groups. A multiple logistic regressian was used to identify the association between activities and delivery mode as well as controlling potential confounding variables. In the analyses, the level of significance was set at P < 0.05. ResultsIn total, 2029 pregnant women participated in the study, among which 1334 (65.84%) underwent CSs and 692 (34.16%) underwent NVDs. The study indicated the odds ratio of CS was 0.68 (95% CI: 0.47–0.97) for a pregnant woman who increased her level of activity during pregnancy compared to pre-pregnancy. ConclusionThe results of this study showed that regular and standard physical activities during pregnancy can reduce the risk of caesarean section in pregnant women. These findings can be important in convincing health care providers to prescribe regular and standard physical activities for pregnant women during pregnancy.

Timing of administration of epidural analgesia and risk of operative delivery in nulliparous women: A case–control randomised study

Background and Aim: Epidural analgesia (EA) offers an effective form of labour analgesia. The time of administration of EA and its relationship with the mode of delivery is controversial. Our study tried to assess whether early initiation of epidural analgesia influences the obstetric outcome in nulliparous women. Materials and Methods: This was a case control, randomised study which included 60 parturients in spontaneous labour divided into two equal groups, the cases and controls. Cases received EA with 10 mL of 0.125% injection bupivacaine, whereas the control group received a systemic opioid (injection pethidine 100 mg intramuscularly) for pain relief. Cases were further divided into parturients receiving EA at a cervical dilatation of 3 cm or less classified as the early epidural group and those receiving EA at 4 cm or more classified as the late epidural group. The modes of delivery for the study population were recorded. Data analysis was done using Wilcoxon two-sample test. P

Predicting Vaginal Delivery in Nulliparous Women Undergoing Induction of Labor at Term.

We sought to develop a model to calculate the likelihood of vaginal delivery in nulliparous women undergoing induction at term. We obtained data from the Consortium on Safe Labor by including nulliparous women with term singleton pregnancies undergoing induction of labor at term. Women with contraindications for vaginal delivery were excluded. A stepwise logistic regression analysis was used to identify the predictors associated with vaginal delivery by considering maternal characteristics and comorbidities and fetal conditions. The receiver operating characteristic curve, with an area under the curve (AUC) was used to assess the accuracy of the model. Of 10,591 nulliparous women who underwent induction of labor, 8,202 (77.4%) women had vaginal delivery. Our model identified maternal age, gestational age at delivery, race, maternal height, prepregnancy weight, gestational weight gain, cervical exam on admission (dilation, effacement, and station), chronic hypertension, gestational diabetes, pregestational diabetes, and abruption as significant predictors for successful vaginal delivery. The overall predictive ability of the final model, as measured by the AUC was 0.759 (95% confidence interval, 0.749-0.770). We identified independent risk factors that can be used to predict vaginal delivery among nulliparas undergoing induction at term. Our predictor provides women with additional information when considering induction.

Intrapartum transperineal ultrasound used to predict cases of complicated operative (vacuum and forceps) deliveries in nulliparous women.

The objective of this study was to investigate the predictive value of intrapartum transperineal ultrasound in the identification of complicated operative (vacuum or forceps) deliveries in nulliparous women. Prospective observational study of nulliparous women with an indication for operative delivery who underwent intrapartum transperineal ultrasound before fetal extraction. Managing obstetricians were blinded to the ultrasound data. Intrapartum transperineal ultrasound was performed immediately before blade application, both at rest and concurrently with contractions and active pushing. Operative delivery was classified as complicated when one or more of the following situations occurred: three or more tractions; a third-/fourth-degree perineal tear; significant bleeding during the episiotomy repair; major tear or significant traumatic neonatal lesion. A total of 143 nulliparous women were included in the study (82 vacuum-assisted deliveries and 61 forceps-assisted deliveries), with 20 fetuses in occiput posterior position. Forty-seven operative deliveries were classified as complicated deliveries (28 vacuum-assisted deliveries, 19 forceps-assisted deliveries). No differences in obstetric, intrapartum or neonatal characteristics were observed between the study groups, with the following exceptions: birthweight (3229±482 uncomplicated deliveries vs. 3623±406 complicated deliveries; p<0.003) and number of vacuum tractions (1.4 uncomplicated deliveries, 4.5 complicated deliveries; p<0.0005). The strongest predictors of a complicated delivery, using the area under the receiver-operating characteristics curve (AUC), were the angle of progression with active pushing (AoP2) (AUC 86.9%) and the progression distance with active pushing (PD2) (AUC 74.5%). The optimal cut-off value for predicting a difficult operative delivery was an AoP2 of 153.5° (sensitivity 95.2%; false-positive rate 5.9%) or PD2 of 58.5mm (sensitivity 95.2%; false-positive rate 7.1%). The sonographic parameters AoP2 and PD2 can be used to predict cases of complicated operative deliveries in nulliparous women.

P04.03: What is the relationship between the cerebroumbilical ratio, operative delivery for fetal distress and time to delivery in nulliparous women?

P04.03: What is the relationship between the cerebroumbilical ratio, operative delivery for fetal distress and time to delivery in nulliparous women?

A Six Year Review of Caesarean Sections at Olabisi Onabanjo University Teaching Hospital Sagamu, South West Nigeria

Caesarean section is one of the most commonly performed major operative procedures. There appears to be an increase in the rate of caesarean delivery in our environment, the safety of the procedure has also improved over decades. However, the procedure is still associated with some complications. The aim of this study was to determine the rate, indications and complications of caesarean sections in Olabisi Onabanjo University Teaching Hospital (OOUTH) Sagamu, Ogun State, Nigeria. This was a six year retrospective study of all caesarean deliveries in OOUTH between January 1st 2009 and December 31st 2014. Relevant informationwas retrieved from the medical records and case notes using a purpose designed proforma. The data was analyzed using IBM-SPSS windows version 21. A total of 1390 caesarean section were performed out of 4219 deliveries during the period of review giving a caesarean section rate of 32.9%. The commonest indication was previous caesarean section (25.2%), followed by obstructed labour (17.0%). Maternal complications occurred in 23.1% of the subjects with wound infection being the commonest. Birth asphyxia was the commonest foetal complication. This study demonstrates a high caesarean section rate in OOUTH. Efforts geared towards reducing primary caesarean sections by encouraging instrumental delivery in nulliparous women and improving skills in destructive vaginal delivery for obstructed labour with intrauterine fetal death will assist in reversing the trend.Keywords: Caesarean section rate, Indications, Complications

Transperineal sonographic assessment of angle of progression as a predictor of successful vaginal delivery following induction of labor.

To assess whether measurement of the angle of progression (AOP) before induction of labor (IOL) can predict successful vaginal delivery in nulliparous women. This was a prospective, observational study of nulliparous women with a singleton term pregnancy and an indication for IOL. Transperineal sonography was used to measure the AOP before cervical ripening. Since all women enrolled had a low Bishop score, 98.6% of them were induced with either intracervical extra-amniotic balloon catheter or vaginal prostaglandin E-2. The staff in the labor ward were blinded to the AOP measurements. Clinical data were retrieved from computerized medical records. Of the 150 women included in the final analysis, 40 (26.7%) delivered by Cesarean section. The median AOP was narrower in women who had a Cesarean delivery than in those who delivered vaginally (90° (interquartile range (IQR), 84-94.5°) vs 98° (IQR, 90.8-105°); P < 0.001). When including only women who underwent Cesarean delivery for non-progression of labor (n = 27) in the analysis, an AOP of > 92° (derived from a receiver-operating characteristics curve) was associated with a successful vaginal delivery in 94.8% of women. Multivariate stepwise logistic regression analysis including maternal age, body mass index, gestational age, estimated fetal weight, fetal head station, indication for IOL and AOP demonstrated that only AOP was independently associated with the prediction of a successful induction. AOP may be a useful sonographic parameter for predicting successful vaginal delivery among nulliparous women at term undergoing IOL; an AOP wider than 92° is associated with a high rate of vaginal delivery. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

53: Predicting vaginal delivery in nulliparous women undergoing induction of labor

53: Predicting vaginal delivery in nulliparous women undergoing induction of labor

Mode of delivery in nulliparous women with gestational hypertension undergoing early term induction of labor

Objective: To evaluate perinatal outcomes in nulliparous women undergoing induction of labor for gestational hypertension at term.Study design: Retrospective cohort study of nulliparous women with gestational hypertension undergoing induction of labor ≥37 weeks. Mode of delivery and perinatal outcomes were compared for women who delivered at 370–6/7, 380–6/7, and ≥390/7 weeks gestation.Results: The cohort included 320 women: 67 (21%) at 370–6/7, 76 (24%) at 380–6/7, and 177 (55%) at ≥390/7. There was no increase in cesarean delivery (CD) in women delivering earlier, with 26.9% (370–6/7), 19.7% (380–6/7) and 29.9% (≥390/7) requiring CD (p values = 0.39). Compared to ≥39 weeks, composite maternal morbidity was lowest in women delivering at 380–6/7 (adjusted odds ratio [aOR] 0.45, 95% confidence interval (CI) 0.24–0.84). Composite neonatal morbidity was similar among the groups. When compared to women delivering at ≥390/7 weeks, women delivered at 380–6/7 were less likely to experience any adverse maternal or neonatal outcome (aOR 0.50, 95% CI 0.28–0.90).Conclusions: Compared to induction of labor at ≥39 weeks, early term induction of labor was not associated with an increased risk of CD in nulliparous women with gestational hypertension.

Analgesia: effects on the first and second stages of labor

Background: This controlled observational study aimed at evaluating the effects of epidural analgesia on the first and second stages of delivery in nulliparous women, referred to the birth centers of the Sant’Omero “Val Vibrata” Hospital and the “San Salvatore” Hospital in L’Aquila, selected in accordance with specific inclusion criteria. Materials and Methods: Between May 1 st , 2012 and April 31 st , 2013, 363 patients were enrolled at the birth centres of the “Val Vibrata” Hospital in Sant’Omero (TE) and of the “San Salvatore” Hospital in L’Aquila. 139 patients received epidural analgesia during labor at the “Val Vibrata” Hospital; 224 patients constituted the control group and went through natural delivery without analgesia at the “Val Vibrata” and “San Salvatore” hospitals. Results: Dilation time was different in the two groups: in the group with analgesia, the median was 2.30 and 3.35 in the control group. The median expulsion time was 2.05 in the analgesia group and 0.40 in the control group. Discussion: The statistical analysis of the study has highlighted the fact the analgesia influences the dilation and expulsion time of labor, confirming on the one hand the clinical evidence, and on the other, adding important results that have not been analyzed by other scientific studies. The results have shown that in nulliparous women, with spontaneous onset of labor, analgesia causes a major reduction in the dilation time of the cervical canal with respect to the control group.

Cervical dilation at time of caesarean delivery in nulliparous women: a population-based cohort study.

Our objective was to describe contemporary practice patterns in the timing of caesarean delivery in relation to cervical dilation, overall and by indication for caesarean. Our secondary objective was to examine how commonly caesarean delivery was performed for labour dystocia at dilations below 4 cm or without the use of oxytocin, overall and between hospitals. Retrospective, population-based cohort study. Ontario, Alberta, and British Columbia, Canada, 2008-2012. Nulliparous women in labour who delivered term singletons in cephalic position. Histograms were used to examine the distribution of cervical dilation at time of caesarean delivery, overall and by indication for caesarean. Funnel plots were used to illustrate variation in hospital-level rates of caesarean deliveries for labour dystocia that were performed early (<4 cm dilation) or without the use of oxytocin. Cervical dilation (in centimetres) at time of caesarean delivery. The population-based cohort comprised 392 025 women, of whom 18.8% had a caesarean delivery. Of first-stage caesareans for labour dystocia in women who entered labour spontaneously, 13.6% (95% CI 12.9, 14.2) had dilations <4 cm [hospital-level inter-quartile range (IQR): 6.2% to 20.0%] and 29.5% (95% CI 28.6, 30.4) did not receive oxytocin to treat their dystocia (hospital-level IQR: 22.1-54.6%). The proportion of caesareans done before 4 cm dilation or without oxytocin varies substantially across hospitals and suggests the need for institutions to review their practices and ensure that management of labour practice guidelines are followed. Many caesareans for labour dystocia are performed early during labour (<4 cm dilation) or without oxytocin.

Exercise during pregnancy and risk of cesarean delivery in nulliparous women: a large population-based cohort study

Vaginal delivery for the first birth is of great importance for further obstetric performance for the individual woman. Given the rising cesarean delivery rates worldwide over the past decades, a search for modifiable factors that are associated with cesarean delivery is needed. Exercise may be a modifiable factor that is associated with type of delivery, but the results of previous studies are not conclusive. The purpose of this study was to investigate the association between exercise during pregnancy and cesarean delivery, both acute and elective, in nulliparous women. We conducted a population-based cohort study that involved 39,187 nulliparous women with a singleton pregnancy who were enrolled in the Norwegian Mother and Child Cohort Study between 2000 and 2009. All women answered 2 questionnaires in pregnancy weeks 17 and 30. Acute and elective cesarean delivery data were obtained from the Medical Birth Registry of Norway. Information on exercise frequency and type was assessed prospectively by questionnaires in pregnancy weeks 17 and 30. Generalized linear models estimated risk differences of acute and elective cesarean delivery for different frequencies and types of exercise during pregnancy weeks 17 and 30. We used restricted cubic splines to examine dose-response associations of exercise frequency and acute cesarean delivery. A test for nonlinearity was also conducted. The total cesarean delivery rate was 15.4% (n=6030), of which 77.8% (n=4689) was acute cesarean delivery. Exercise during pregnancy was associated with a reduced risk of cesarean delivery, particularly for acute cesarean delivery. A nonlinear association was observed for exercise frequency in weeks 17 and 30 and risk of acute cesarean delivery (test for nonlinearity, P=.003 and P=.027, respectively). The largest risk reduction was observed for acute cesarean delivery among women who exercised >5 times weekly during weeks 17 (-2.2%) and 30 (-3.6%) compared with nonexercisers (test for trend, P<.001). Reporting high impact exercises in weeks 17 and 30 was associated with the greatest reduction in risk of acute cesarean delivery (-3.0% and -3.4%, respectively). Compared with nonexercisers, regular exercise and high-impact exercises during pregnancy are associated with reduced risk of having an acute cesarean delivery in first-time mothers.

The Effect of a Training Program During Pregnancy on the Attitude and Intention of Nulliparous Women to Choose the Delivery Mode

Background & aim: Despite the advantages of natural childbirth and complications associated with cesarean section, rate of cesarean delivery has increased dramatically in recent years. Therefore, appropriate training is essential to reducing this trend. This study aimed to evaluate the effects of training about the benefits of natural childbirth on the attitude and intention to select the mode of delivery in nulliparous women. Methods: This randomized clinical trial was conducted on 64 nulliparous women with normal pregnancy at 30-34 weeks of gestation without indication for cesarean section referring to the health centers of Mashhad, Iran in 2014. Participants were randomly divided into two groups of intervention (training) and control. Training was focused on the benefits of natural delivery and performed in four sessions (60 minutes) using videos and slides. In both groups, pre-test and post-test were carried out using valid and reliable questionnaires. Data analysis was performed in SPSS V.22 using Fisher's exact test, Chi-square, Wilcoxon test, T-test, and Mann-Whitney U test. Results: Mean score of attitude toward natural delivery had a significant difference in the intervention group before and after training (P<0.001). Mean difference in the score of attitude toward cesarean section was significantly higher in the intervention group compared to control group (P<0.001). Moreover, frequency of intentions to select the mode of delivery was significantly different in the intervention group before and after training (P=0.004). Conclusion: According to the results of this study, training on the benefits of natural childbirth could positively influence the attitude of pregnant women toward natural delivery and reduce the rate of elective cesarean section.

Задержка рождения второго и третьего плодов при многоплодной беременности тройней (Клинический случай)

This article describes a clinical case of vaginal delivery in nulliparous women 24 years old delayed interval delivery of the second and third fetuses in spontaneous multiple pregnancy dichorionic triamniotic triplet in a tertiary perinatal center. After preterm delivery in 27+5 weeks of gestation the first fetus to reduce perinatal morbidity and mortality of two fetuses that are left in the uterus, with informed consent of the woman preterm delivery the second and third fetuses occurred at intervals of 38 days, in 33+1 weeks of gestation. Careful monitoring of the state of the mother and fetuses was conducted. To increase the interval between the birth of the first fetus and the second and the third fetuses, prevention of obstetric and perinatal complications used tocolysis, antibiotics, progesterone, the prevention of respiratory distress syndrome of the newborn by corticosteroids and bed rest. Three girls were born alive with a weight of 980, 1800 and 1950 grams correspondingly. Childbirth complicated second degree perineal laceration and retained portions of placenta and membranes, puerperal period was uneventful. After 1.5 months, all infants discharged with her mother in a satisfactory condition with a weight of more than 3000 grams. Key words: multiple pregnancy, triplet pregnancy, delayed interval delivery in triplet pregnancy, preterm delivery.

A randomized trial of Foley balloon induction of labor trial in nulliparas (FIAT-N)

With an increasing rate of induction of labor, it is important to choose induction methods that are safe and efficient in achieving a vaginal delivery. The optimal method for inducing nulliparous women with an unfavorable cervix is not known. We sought to determine if induction of labor with simultaneous use of oxytocin and Foley balloon vs sequential use of Foley balloon followed by oxytocin decreases the time to delivery in nulliparous women. We conducted a randomized controlled trial of nulliparous women presenting for induction at a single institution from December 2013 through March 2015. After decision for induction was made by their primary provider, women with gestational age ≥24 weeks with a nonanomalous, singleton fetus in vertex presentation with intactmembranes were offered participation. Exclusion criteria included history of uterine surgery, unexplained vaginal bleeding, latex allergy, or contraindication to vaginal delivery. Participants were randomized to either simultaneous (oxytocin and Foley balloon) or sequential (oxytocin after expulsion of Foley balloon) induction group. The primary outcome was time from induction to delivery. Secondary outcomes included mode of delivery, estimated blood loss, postpartum hemorrhage, chorioamnionitis, and composite neonatal outcome. Maternal and neonatal outcomes were collected via chart review. Analyses were done on an intention-to-treat basis. A total of 166 patients were enrolled; 82 in the simultaneous and 84 in the sequential group. There were no differences in baseline characteristics in the 2 groups. Patients who received simultaneous oxytocin with insertion of a Foley balloon delivered significantly earlier (15.92 vs 18.87 hours, P= .004) than those in the sequential group. There was no difference in rate of cesarean delivery, estimated blood loss,postpartum hemorrhage, chorioamnionitis, or composite neonatal outcome. Simultaneous use of oxytocin and Foley balloon for induction of labor results in a significantly shorter interval to delivery in nulliparas.

Comparison of obstetric anal sphincter injuries in nulliparous women before and after introduction of the EPISCISSORS-60(®) at two hospitals in the United Kingdom.

AimTo assess whether the introduction of episiotomy scissors specially designed to achieve a cutting angle of 60°, EPISCISSORS-60®, in two hospitals in the UK would result in a reduction in obstetric anal sphincter injuries (OASIS) in nulliparous women.MethodsA structured training program for all doctors and midwives provided a theoretical framework around OASIS including risk factors and the role of episiotomies and a practical hands-on training element to use EPISCISSORS-60® correctly and to measure perineal body length and post-suturing angles. Data for perineal body length, post-suturing angles, user feedback, episiotomy use, and incidence of OASIS were collected through specifically designed forms and the general hospital data collection system.ResultsData were available for 838 nulliparous vaginal deliveries. Mean perineal body length was 37 mm in spontaneous vaginal delivery group (standard deviation [SD] =8.3, 95% confidence interval [CI] =34–39) and 38 mm in the operative vaginal delivery group (SD=8, 95% CI=35–40). Post-suturing episiotomy angles were 53° (SD=6.5, 95% CI=50.7–55.8) in spontaneous vaginal deliveries and 52° (SD=9.6, 95% CI=49–54) in operative vaginal deliveries. EPISCISSORS-60® were rated as “good” to “very good” by 84% of users. There was a 47% increase in the number of episiotomies in nulliparous spontaneous vaginal deliveries at Poole (P=0.007) and a 16.5% increase in the number of episiotomies in nulliparous operative vaginal deliveries in Hinchingbrooke (P=0.003). There was an overall 11% increase in episiotomy numbers in nulliparous vaginal deliveries (P=0.08). There was a statistically significant OASIS reduction of 84% in nulliparous spontaneous vaginal deliveries in women who received an episiotomy (P=0.003).ConclusionInitial results after introduction of EPISCISSORS-60® show that the majority of health care professionals achieve post-suturing episiotomy angles between 40° and 60°. The results also show a significant increase in the use of episiotomies in the delivery of nulliparous women. There has been a statistically significant reduction in OASIS in nulliparous spontaneous vaginal deliveries.