Comparison of episiotomy outcomes and obstetric anal sphincter injury (OASIS) using Episcissors-60 vs. Busch scissors: A randomised controlled trial

Background and objectives Obstetric anal sphincter injuries (OASIS) are a significant cause of maternal morbidity. The episiotomy angle plays a key role in determining OASIS risk. The present study compared the effectiveness of Episcissors-60 with conventional Busch scissors in reducing OASIS. Methods In this parallel-arm randomised controlled trial, 400 primigravida women undergoing vaginal delivery were randomised to mediolateral episiotomy using either Episcissors-60 (n=200) or Busch scissors (n=200). Primary outcomes included episiotomy angle, episiotomy characteristics, and incidence of OASIS. Secondary outcomes included vaginal tears and postpartum haemorrhage. Results The mean episiotomy angle was significantly higher in the Episcissors-60 group compared to the Busch group (38.4° vs . 35.6°, P =0.013). OASIS incidence was significantly lower with Episcissors-60 [5 (2.5%) vs. 15 (7.5%); P =0.017), corresponding to a 73.3% risk reduction. There were no significant differences in episiotomy length, distance from anus, birth weight, or postpartum haemorrhage. Vaginal tears occurred only in the Busch group but were not statistically significant. Interpretation and conclusions Episcissors-60 results in more optimal episiotomy angles and significantly reduces OASIS without increasing complications. These findings support its use for improving perineal outcomes during vaginal delivery.