Episiotomy Suturing Research Articles

A Study to Develop and Evaluate the Effectiveness of an Information Booklet on Self-Perineal Care Management and Prevention of Complications after Episiotomy Suturing in Terms of Gain in Knowledge and Practice of Post-Natal Mothers in Selected Hospitals of Agra

A Study to Develop and Evaluate the Effectiveness of an Information Booklet on Self-Perineal Care Management and Prevention of Complications after Episiotomy Suturing in Terms of Gain in Knowledge and Practice of Post-Natal Mothers in Selected Hospitals of Agra

How COVID-19 pandemic affected clinical exposure of final year medical students: A comparison study of portfolio assessments

Background and Objective COVID-19 restrictions had a major impact on the academic sector globally. The aim of this study was to compare the clinical exposure of final year medical students at the professorial unit of Obstetrics and Gynaecology of Colombo South Teaching Hospital during the COVID-19 pandemic with those who attended clinical training prior to the pandemic. Methods Systematic sampling of 66 medical students belonging to two clinical groups, who had completed their professorial Obstetrics and Gynaecology appointment during the pandemic, was done, using their student portfolios recording the clinical skills and procedures performed during the appointment. The pre-COVID-19 data were gathered from a previous study carried out in the same unit in 2018. Results Most students managed to complete both the Gynaecological and the Obstetrics Mini–Clinical Evaluation Exercise (62.1% and 56.1% respectively) but, compared to the pre-pandemic era, a higher percentage presented only one case or none. All students completed the Objective Structured Assessment of Technical Skills in episiotomy suturing (100%) and a majority (90.9%) performed artificial rupture of membranes (ARM). However, only 36.4% had the opportunity to perform a PAP smear independently. Majority (95.1%) of the cases were presented to the registrars attached to the unit while only a minority was evaluated by a consultant (3.8%). The Obstetric and Gynaecological clinical procedures and skill acquisition showed slightly lower percentages than in the pre-COVID-19 period with the means and the medians lying in between the 1st and 2nd quartiles of the distribution. Conclusion On average, there was a slight decrease in the clinical exposure to procedures and skills during the COVID-19 outbreak compared to the non-COVID-19 period. Additionally, the opportunity of the medical students to be supervised by a consultant Obstetrician and Gynaecologist reduced drastically during the pandemic.

Blended Teaching Methodology of E-learning and Simulation Training in Obstetrics and Gynecology for Undergraduate Medical and Nursing Trainees.

Context The concept of simulation-based teaching has become a standard practice for health education in the present era. However, there is a paucity of literature on integrating simulation-based teachingin the conventional training of undergraduate medical and nursing students. Aim To explore the effectiveness and benefits of e-learning along with low-fidelity simulation in obstetrics and gynecology among undergraduate medical and nursing students at a tertiary care centerin India. Methodology It was a prospective study conducted on 53 final-year undergraduate medical students and 61 final-year undergraduate nursing students. All students underwent a knowledge-based pre-test followed by exposure to an e-learning module on four selected obstetrics and gynecology skills, namely, conducting normal delivery, episiotomy suturing, pelvic examination, and insertion of intrauterine device. Students practiced these four skills on low-fidelity simulators. After this, they underwent a post-test assessment and gave feedback. A focused group discussion was conducted to explore their experiences. Results There was a statistically significant difference between the pre-test and post-test knowledge scores of all the students (p =< 0.001). Students found this teaching strategy useful and reported an increase in self-assessed confidence. Focused group discussion revealed various themes like improved satisfaction and ability to practice repeatedly without fear of harming patients. Conclusions Based on the results, this teaching methodology should be integrated as an adjunct method of teaching in the undergraduate curriculum from the first year itself, which will motivate students to participate in clinical care and will result in quality improvement of health care.

MIDWIFE CARE FOR NORMAL NEWBORN BABIES NY. N AT HJ. HENDRAYATNI CLINIC, PEMATANGSIANTAR CITY

Post episiotomy post pain rates vary due to incision and suturing at the time of episiotomy causing sharp pain with different levels This is due to the activation of peripheral nociceptors which is a special receptor conducting noxious stimulus. There are as many as 70.9% of mothers experiencing pain around the episiotomy sutures and there are as many as 73% post episiotomy pain is very disturbing maternal comfort resulting in difficulty during bowel movements, urination, and insomnia. Scientifie Writing is at implementing Nutrition Midwifery Management at Ny “S” with Episiotomy Injury at Universitas Efarina Pematngsiantar Year 2020 in accordance with 7 steps Varney and SOAP. The result of a case study that had been done on Ny “S” with episiotomy injury, no obstacles found during the care provided. The results of a case study that had been done on Mrs “S” with episiotomy injury, no obstacles found during the care provided. Monitoring is done 5 times for approximately 1 month. During the treatment and home visits, there was pain in the episiotomy wound since after the mother gave birth on June 02, July 2020 until the 4th day of the puerperium, 1 week postpartum Mrs “S” did not feel episiotomy wound pain, but 2 week back maternal period feel the pain in her genitals after doing coitus. After care and monitoring on Ny “S” the pain has stopped, and the episiotomy suture has dried and healed. The conclusion of the case study that is 7 steps Varney and SOAP used for the proces of problem solving obstetrics have been done assessment and data analysis on the case of Ny “S” with episiotomy injury in Klinik Mandiri Midwife M.

Effect of early skin-to-skin contact after vaginal delivery on pain during perineal wound suturing: A randomized controlled trial.

To evaluate whether early skin-to-skin contact at the end of the second stage of labor could relieve perineal wound suture pain. From March 2020 to November 2020, a total of 241 parturients with full-term single fetuses delivered through the vagina and who underwent episiotomy suture (n=120) or perineal laceration repair (n=121) in our hospital were included in the study. Parturients were categorized according to whether they received episiotomy suture or perineal laceration repair. They were randomized into an early skin contact group and a traditional neonatal care group. The primary outcome was pain, which was quantified by the Numerical Rating Scale, Visual Analog Scale, Verbal Rating Scale, Faces Pain Scale-Revised. The secondary outcomes were healing of the perineal wound, the maternal cooperation rate and operation time. The confounding factors of severe pain were analyzed. Early skin-to-skin contact alleviated the pain of perineal laceration repair and episiotomy suture, shortened the operation time of episiotomy suture and improved the cooperation rate of parturients receiving suture. It had no effect on perineal wound healing, operation time, or the cooperation rate of perineal laceration repair. In addition to the operation and early skin contact, the occurrence of high-grade pain was also associated with prepregnancy body mass index, group B streptococcus (GBS) positive, and academic degree. Early skin-to-skin contact at the end of the second stage of labor can alleviate pain and improve the delivery experience of vaginal delivery.

Midwifery Care for Postpartum Mothers with Discomfort Pain of Episiotomy Stitches at PMB Ernyadi Sidoarjo

The pain due to the episiotomy is not the same, the intensity of the pain is different. This pain is due to the active peripheral nociceptors, which are receptors in particular, which are responsible for delivering to noxious stimuli. This midwifery care is aimed at dealing with complints to Mrs.P history of episiotomy at BPM Ernyadi Sidoarjo with the method of collecting initial data to evaluation the results obtained by Mrs.P a history of episiotomy. Did not find any difficulties at the time the care was given this study was carried out at 2 hours of the puerperium the mother gave birth on January 12, 2020 at 19.15 spontaneously an episiotomy was carried out on the indication of a stiff perineum according to the theory the conclusion from the case study with the initial data collection method to the eva;uation of the problem Mrs.P all the findings and all the actions that have been implemented, Mrs there was no difference between the theory and no signs of infection in the episiotomy suture scars.

Comparative study of continuous method and interrupted method of episiotomy in terms of healing of the surgical wound

Episiotomy is a most commonly performed minor procedure. There are various type of episiotomy suturing, in this study two most common types of episiotomy suturing techniques were compare in terms of healing rate. This study concluded that the continuous method of episiotomy suturing is although faster, cosmetically better and associated with less post-operative pain but it heals significantly better than interrupted method of suturing.

COMPARATIVE STUDY OF CONTINUOUS METHOD AND INTERRUPTED METHOD OF EPISIOTOMY IN TERMS OF HEALING OF THE SURGICAL WOUND.

Episiotomy is a most commonly performed minor procedure. There are various type of episiotomy suturing, in this study two most common types of episiotomy suturing techniques were compare in terms of healing rate. This study concluded that the continuous method of episiotomy suturing is although faster, cosmetically better and associated with less post-operative pain but it heals signicantly better than interrupted method of suturing

Feasibility of maintaining a portfolio for a professorial appointment in obstetrics and gynaecology in a low resource setting

Objective: The main objective of this study is to assess the feasibility in replacing the portfolio in a low resource setting and its acceptance amongst the students and staff. Synopsis: The objective for the study with regards to using portfolios: is it feasible for the 2 month professorial appointment in a low resource setting and its acceptance amongst the students and staff. Methods: The study was conducted on 259 final year medical students for a period of two years from 2016 to 2018, using the student portfolio maintained by them during their professorial gynaecology and obstetrics appointment which is of 8 weeks duration, and the feedbacks provided by students and staff. Results: Around 2 mini clinical evaluation exercise (CEX) were completed for gynaecology and obstetrics and 1 OSAT each was completed of the five different technical skills by all students. All of them completed the objective structured assessment of technical skills (OSATS) in episiotomy suturing, urine catherization and cannulation, 96% of the students were assessed on their skills for artificial rupture of membrane (ARM) and in setting up as an intravenous drip. Students managed to obtain feedback from patients, peers and nursing officers.100% positive feedback was given by the patients, 97% from peers and 92% from the nursing officers. 80% of all the logs in the portfolio were completed by the students. On an average 2 reflective writings were completed per student. 97% of the students found it as a useful tool and 97% stated that it can be easily completed. Conclusion: Introduction of a portfolio for the obstetrics and gynaecology professorial appointment for medical students is possible, with good student satisfaction despite higher number of student: staff ratios.

The Effect of Simulation Teaching Technique on the Improvement of Episiotomy Performance Skills and State Anxiety of Midwifery Students in Turkey: RCT

BackgroundSeveral methods have been developed to improve the episiotomy skills of midwifery students. This study was conducted to determine the effect of episiotomy simulation training on the episiotomy skills of midwifery students and their state anxiety levels. MethodsThis study is a quasi-experimental randomized controlled trial. Its sample consisted of 68 third-year students in the midwifery department of a university in Turkey. The students were randomly divided into experimental (34) and control (34) groups. The study data were collected using a sociodemographic information form, the State Anxiety Inventory (STAI) and the Episiotomy Skill Assessment Form. All the data collection tools were administered during the fall semester of 2018-2019. ResultsAfter the delivery room practice, the simulation group had significantly higher Episiotomy Skill Assessment Form scores (p < .05). The simulation did not affect state anxiety, and the students experienced mild anxiety. ConclusionThe episiotomy skill performance of the students in the episiotomy suture simulation group was significantly higher than that of the control group, but the use of simulation did not reduce the students’ state anxiety.

In women with spontaneous vaginal delivery, repair of perineal tears might be easier compared to episiotomy.

To examine a common assumption that suturing of episiotomy, a straight performer-controlled incision, might be easier compared to repair of unpredictable spontaneous perineal tears. Data for this study were collected prospectively, as part of a randomized controlled trial examining the outcomes of episiotomy avoidance. Suturing characteristics were compared between vaginal deliveries with episiotomy vs. spontaneous perineal tears. Primary outcomes included the duration of the repair, number of suture packs used for the repair, and subjective rating of suturing difficulty (rated from 1 to 5 by practitioner performing the suturing). Of 525 vaginal deliveries, episiotomy was performed in 165 (31.4%) of the cases, 59 of which (35.8%) were accompanied by additional vaginal tears. Spontaneous vaginal tears without episiotomy were noted in 272 deliveries (51.8%). Compared to spontaneous perineal tears, episiotomy performance was associated with an adverse effect on all three suturing characteristics in the overall cohort and in subgroup of non-operative deliveries. When comparing episiotomy only to second-degree tear suturing, in the subgroup of non-operative vaginal deliveries a higher rate of suturing duration < 10min was noted in favor of spontaneous tears. However, in sub-analysis of vacuum-assisted deliveries, a benefit was noted in favor of the episiotomy-only group in terms of fewer suture packs and lower subjective difficulty. In women with non-operative vaginal delivery, suturing of spontaneous perineal tears was easier and shorter compared to episiotomy repair. This might be related to the unpredictable nature of perineal tears, which might be shorter and shallower compared to the standard episiotomy incision.

A prospective clinical audit evaluating the incision angle at mediolateral episiotomy for vaginal delivery

Background: Increasingly, the angle at which the episiotomy is performed has come under scrutiny. The current recommendation is that because of distortion of the anatomy at crowning of the head, the incision should be at an angle of at least 60° from the midline to ensure that a post-delivery angle of 43° is achieved. Method: A prospective clinical audit was performed in Castle Street Hospital for Women, Colombo, Sri Lanka, evaluating the post-delivery angle after suturing of episiotomy in a sample of consecutive vaginally delivered women. The angle after repair was defined as the angle formed by the suture line and the midline is measured at the end of the suturing. OASI Care Bundle, recently developed by the RCOG was used as the gold standard reference. Results: A total of 105 consecutive vaginal deliveries with mediolateral episiotomy were evaluated. Mean age (SD) was 27.9 (6.0) years. Mean gestational age (SD) was 39.3 (1.7) and mean birthweight (SD) was 3.0 (0.5) kg. There were 97 (92.4%) spontaneous vaginal deliveries and 21 (20.0%) were diabetic. Majority, 48 (45.7%) had their first delivery. There were 6 (5.7%) third degree perineal tears and 24 (22.9%) had additional second degree perineal tears. Out of 105, 91 (86.7%) women had post-delivery angle of less than 45° and 33 (31.4%) of them were less than 30°. Only 14 (13.3%) episiotomies were having the correct post-delivery angle (45°). Majority (55.2%) had not been started from the midline. Conclusion: Current practice of incision angle at medio-lateral episiotomy is not satisfactory. Training using ‘Episiotomy angle-cutter demonstrator’ in the OASI Care Bundle has been planned before the re-audit.

A Comparative Study of Continuous Versus Interrupted Suturing of Episiotomy

The role of convention repair of episiotomy has come under scrutiny in recent years.This procedure has nowbeen modified from interrupted suturing earlier to continuous stitching of episiotomy.Aim &amp;objectives :-This study was done to evaluate the patient comfort &amp; post-op complications betweenconventional repair &amp; continuous repair of episiotomy .Methodology:-This prospective study was conducted in the department of Gyne &amp; obstr of Rama medicalcollege, Hapur from July 2018 to June 2019 on 200 patients who were randomly divided into two groupsof 100 patients each . In Group A (study group), episiotomy repair was performed by continuous stitching &amp;group B underwent conventional interrupted suturing repair. Post operatively the efficacy of both proceduresanalysed on the basis of outcome in form of pain &amp; other complications.Result :- Majority of patients of episiotomy were in age group of 18 to 26 years. Mean gestational periodwas 38.4+0.6 &amp; 38.4+0.5 for the study &amp; control group. The mean suturing time was also significantlyshorter for study group.Pain score was significantly less after 48 hrs. Resumption of sexual activity wassignificantly shorter in study group.Conclusion :- The success rate was significantly better in continuous repair group in the form of lessprocedure time, suture material , postpartum pain &amp; early resumption of sexual activity

1081: Suturing of episiotomy incision is not easier than repair of spontaneous perineal tears

Episiotomy is a common procedure worldwide; however, its value in prevention of various maternal and neonatal complications remains unproven. One of the common assumptions is that suturing of episiotomy, a straight incision which length and depth are determined by the obstetrician, might be easier compared to repair of unpredictable spontaneous perineal tears. The objective of our study was to examine this hypothesis. The data for this study was collected prospectively, as part of randomized controlled trial that examined the effects of episiotomy avoidance on advanced perineal tears in women towards their first vaginal delivery, compared to standard care. For the current analysis we compared suturing characteristics between two groups: vaginal deliveries in which episiotomy was performed, vs. deliveries with spontaneous perineal tears. Suturing characteristics included the duration of the repair, amount of suture packs and subjective rating of suturing difficulty (rated from 1 to 5). Of 525 vaginal deliveries, episiotomy was performed in 165 (31.5%) of the cases, 60 of which (36.4%) were accompanied by additional vaginal tears. Spontaneous vaginal tears without episiotomy were noted in 182 deliveries. The two groups did not differ in terms of various demographic and obstetric characteristics (age, body mass index, gestational age or birthweight); however, in the episiotomy group longer second stage and a higher percentage of vacuum extraction deliveries were noted (Table 1). No difference in the amount of suture packs or suturing difficulty was found between the two groups; however, in episiotomy group significantly higher rates of suturing duration above 10 minutes were noted (Table 1). According to our results, suturing of episiotomy is not easier, and might even be more complicated than the repair of spontaneous perineal tears. It might be related to the unpredictable nature of perineal tears, which might be shorter and shallower compared to the standard episiotomy incision.

Are we performing episiotomies correctly? A study to evaluate French technique in a high-risk maternity unit

IntroductionThe aim of this study was to evaluate episiotomy technique, in particular suture angles, and any correlation between suture angle and severe perineal tears. Material and methodsAn observational questionnaire-based study was conducted between 01 August 2015 and 30 April 2016 among accoucheurs performing episiotomies in a French maternity unit with facilities for high-risk pregnancies. For each patient included, accoucheurs were asked to measure the episiotomy suture angle, and to record the angle at which they thought they had cut, the length of the episiotomy, its distance from the anus, and whether the woman sustained a sphincter injury. ResultsThe centre's episiotomy rate during the study period was 15%. We analyzed the characteristics of episiotomies performed on 89 women (68 by doctors and 21 by midwives). Only 43% of suture angles were between 45° and 60° (45.6% of those performed by doctors vs 38.1% by midwives, p=0.8623), whereas 91% of accoucheurs thought they had cut within the correct range. Doctors made longer incisions than midwives (4 [4.2–5.0] vs 3 [2.5–3.5] cm, p=0.0006). Only 40.5% of accoucheurs correctly estimated the incision angle. Twelve (13.64%) of the 88 women sustained a third-degree perineal tear. The risk of sphincter injury was higher with suture angles <45° (odds ratio 5.46 [1.11–26.75], p=0.037). After multivariate analysis, this result was no longer significant (p=0.079). ConclusionIt appears that many accoucheurs have difficulty estimating episiotomy incision angles correctly and that education and training in this domain requires improvement.

Effectiveness of breast crawl on the intensity of episiotomy pain and behavioral response among women during episiotomy suturing

Background: Methods to provide comfort and relieve pain are of paramount importance for the child bearing woman. Unfortunately very little importance is given to reduce the pain and discomfort of the women during episiotomy suturing. Aim: The aim of the study was to assess the effectiveness of breast crawl on the intensity of episiotomy pain and behavioural response among women during episiotomy suturing. Method: A quasi experimental design with a sample size (N=40) were selected using purposive sampling technique. The data were obtained by using a baseline proforma for the mother, Visual Analogue Scale (VAS) and an observation checklist. Statistical analysis was done using SSPS. Results: Findings showed that the present study findings also revealed that there is a significant difference in the mean scores of behavioural response of mothers during suturing between the experimental and control group (t38= 2.042, P < 0.05). Also there is a significant difference in the mean scores of reduction in intensity of episiotomy pain of mothers during suturing between the experimental and control group (t38=2.042, P < 0.05). Hence breast crawl is effective in reducing the intensity of pain during episiotomy suturing and there is a favourable behavioural response among women who received breast crawl during episiotomy suturing. Conclusion: The findings concluded that breast crawl is a simple and cost effective method to reduce the intensity of episiotomy pain in women during episiotomy suturing. Nurses can in co operate this practice and thus initiate the bond of motherhood.

Evaluation of training programme uptake in an attempt to reduce obstetric anal sphincter injuries: the SUPPORT programme

The objective was to assess the feedback from a quality improvement training programme to reduce obstetric anal sphincter injuries (OASIS). Training sessions were organised that included evidence-based information on OASIS risk factors and training on models to measure perineal body length (PBL), perform episiotomies with standard and 60° fixed angle scissors (EPISCISSORS-60®), and measure post-delivery episiotomy suture angles with protractor transparencies. Feedback forms using a Likert scale (1-4) were completed and analysed. The setting was an evidence-based quality improvement programme (Strategy for Using Practical aids for Prevention of OASIS, Recording episiotomies and clinician Training [SUPPORT]) at two National Health Service (NHS) Hospitals in the UK. The participants were midwives and doctors attending the SUPPORT training programme RESULTS: All of the participants (100%) would recommend the training programme to a friend or colleague. 92% felt that the training session improved their knowledge of the impact of PBL and perineal distension and their knowledge of the relationship between episiotomy angle and OASIS "a lot" or "somewhat". Based on this feedback, we recommend the addition of the knowledge content of the SUPPORT programme to other centres providing perineal assessment and repair courses.

Comparative Study of Continuous Vs. Intermittent Technique of Episiotomy Suturing in Rural Population of India

Comparative Study of Continuous Vs. Intermittent Technique of Episiotomy Suturing in Rural Population of India

Behavior of perineum during delivery before fetal head expulsion.

The aim of this study was to describe perineum deformation during the final part of delivery and suggest a modification of the episiotomy cut to increase accuracy for obtaining a suitable angle (45°) for surgical wound suture. This prospective study enrolled 45 primiparous women. The perineum at rest was marked with five lines (0°, 30°, 45°, 60°, 90°), and each line was marked with two dots (point A-B: to 2-3cm from initial point in fourchette, respectively). Two digital pictures were taken: one with the women at rest and the second during fetal head crowning; displacements were calculated for each point and angle. When the perineum is distending, the initial point of every line in the posterior fourchette moves laterally in introitus (only the 0° line remains at midline). The angle and the distance to points A and B of each line drawn do not change significantly from at rest to crowning. However, comparing original line configuration with an imaginary line from the fourchette to points A and B before expulsion, the angle and the distance is increased statistically significantly. Perineal distension at the moment of fetal head crowning causes a linear displacement of the perineum, which causes the difference in angle between the incision and episiotomy suture. Therefore, to obtain an episiotomy suture from fourchette with an angle of 45°, theoretically, we would have several angle incision options (between 45° and 60°), with a less acute angle when the introitus cut is closer to the fourchette (45° to 6mm and ∼60° in the fourchette) and a sharper angle with a longer episiotomy.

Obstetric anal sphincter injuries: review of anatomical factors and modifiable second stage interventions

Obstetric anal sphincter injuries (OASIs) are the leading cause of anal incontinence in women. Modification of various risk factors and anatomical considerations have been reported to reduce the rate of OASI. A PubMed search (1989–2014) of studies and systematic reviews on risk factors for OASI. Perineal distension (stretching) of 170 % in the transverse direction and 40 % in the vertical direction occurs at crowning, leading to significant differences (15–30°) between episiotomy incision angles and suture angles. Episiotomies incised at 60° achieve suture angles of 43–50°; those incised at 40° result in a suture angle of 22°. Episiotomies with suture angles too acute ( 60°) are associated with an increased risk of OASI. Suture angles of 40–60° are in the safe zone. Clinicians are poor at correctly estimating episiotomy angles on paper and in patients. Sutured episiotomies originating 10 mm away from the midline are associated with a lower rate of OASIs. Compared to spontaneous tears, episiotomies appear to be associated with a reduction in OASI risk by 40–50 %, whereas shorter perineal lengths, perineal oedema and instrumental deliveries are associated with a higher risk. Instrumental deliveries with mediolateral episiotomies are associated with a significantly lower OASI risk. Other preventative measures include warm perineal compresses and controlled delivery of the head. Relieving pressure on the central posterior perineum by an episiotomy and/or controlled delivery of the head should be important considerations in reducing the risk of OASI. Episiotomies should be performed 60° from the midline. Prospective studies should evaluate elective episiotomies in women with a short perineal length and application of standardised digital perineal support.