Curved versus straight scissors to avoid 3rd and 4th degree perineal tears: a randomised feasibility study

Swift, Angela, Webster, Joan, Conroy, Annette Mary, Hampton, Sue, Kirby, Sarah Jane, Minuzzo, Lee and Kimble, Rebecca (2014) Curved versus straight scissors to avoid 3rd and 4th degree perineal tears: a randomised feasibility study. Women and Birth, 27 3: 163-167. doi:10.1016/j.wombi.2014.06.001

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Author Swift, Angela
Webster, Joan
Conroy, Annette Mary
Hampton, Sue
Kirby, Sarah Jane
Minuzzo, Lee
Kimble, Rebecca
Title Curved versus straight scissors to avoid 3rd and 4th degree perineal tears: a randomised feasibility study
Journal name Women and Birth   Check publisher's open access policy
ISSN 1871-5192
Publication date 2014-09
Year available 2014
Sub-type Article (original research)
DOI 10.1016/j.wombi.2014.06.001
Open Access Status
Volume 27
Issue 3
Start page 163
End page 167
Total pages 5
Place of publication Amsterdam, The Netherlands
Publisher Elsevier
Collection year 2015
Language eng
Formatted abstract
Severe perineal tears sustained during childbirth cause significant distress and morbidity amongst women. The objective of this study was to compare the use of straight scissors for cutting an episiotomy with the use of curved scissors, which are designed to curve away from the anal sphincter.

We used a single-centre, randomised feasibility trial. The intervention was the use of curved scissors. Women were recruited during a prenatal visit and randomised in the delivery suite, when it became clear that an episiotomy was required. The feasibility outcomes were the proportion of women able to be recruited, randomised and followed up. We also calculated the incidence of obstetric anal sphincter injury when either straight or curved scissors were used to cut an episiotomy. Other outcomes assessed were pain, length of hospital stay, perineal infection and perineal dehiscence.

Of the 155 patients recruited in the prenatal period, only 20 (12.9%) were eventually randomised at birth. The main reasons for the high loss were that women either did not have a vaginal delivery (38, 24.5%), or they did not need an episiotomy (72, 46.5%). Rates of obstetric anal sphincter injury and other outcomes were similar between groups.

Anal sphincter injury during childbirth remains an important problem. Although the use of curved scissors provides a theoretical solution, we found that the high attrition rate made feasibility of conducting a suitably powered, randomised trial using the current design untenable. Alternative strategies have been suggested to make any future study more viable.
Keyword Episiotomy
3rd degree tear
4th degree tear
Obstetric anal sphincter injury
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Nursing, Midwifery and Social Work Publications
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Created: Fri, 13 Mar 2015, 11:43:26 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work