Episcissors-60 in Obstetrics Anal Sphincter Injury (OASI): A Systematic Review and Meta-Analysis.

Authors

Wesam Hammouri, Victoria Kershaw, Aethele Khunda, Sami Shawer, Paul Ballard

Published in

International urogynecology journal. Jul 07, 2026. Epub Jul 07, 2026.

Abstract

Obstetric anal sphincter injury (OASI) can be minimised with appropriate use of episiotomy [1]. Episcissors-60 were designed to improve the accuracy of mediolateral episiotomy [2]. The National Institute of Health and Care Excellence (NICE) have recommended research to address the uncertain efficacy of Episcissors-60 in OASI prevention [3]. This systematic review aims to evaluate Episcissors-60 in OASI prevention.
The review was registered with Prospero-University of York. A literature search using MEDLINE, EMBASE and CINAHL databases was performed up to 31 August 2023, without limits and updated March 2025. Included studies had a comparator group: historic or parallel. Studies were screened according to PRISMA protocol [4] by two independent reviewers. Data were extracted for quantitative synthesis using RevMan5.4.1.
Eight studies were included in systematic review and meta-analysis. Two studies were randomised; the remainder were observational. Six studies were deemed high quality ≥ 7 Newcastle-Ottawa score. Six out of eight studies reported a reduction in OASI with Episcissors-60. Participants ranged from 63 to 18,880. When data were pooled; there was a significant reduction in OASI rate in total number of vaginal deliveries (RD -0.02, 95% CI[-0.04, -0.01], p = 0.009) with Episcissors-60. However, there was no significant difference in OASI rate in episiotomy deliveries (RD -0.02, 95% CI[-0.05, 0.00], p = 0.10), nor in episiotomy rate (RD 0.01, 95% CI[-0.02, 0.04], p = 0.45).
Although Episcissors-60 did not show a significant reduction in OASI rate in episiotomy deliveries, a protective effect was observed in the overall number of vaginal deliveries. This suggests a potential Hawthorne effect, warranting an adequately powered randomised controlled trial (RCT) for accurate assessment.

PMID:
42412133
Bibliographic data and abstract were imported from PubMed on 07 Jul 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.