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We compared the clinician’s ability to cut episiotomies at the recommended 60A degrees angle with traditional straight Mayo scissors compared with patented fixed-angle episiotomy scissors EPISCISSORS-60A (R) in a simulated setting using mounted incision pads. The hypothesis was that fixed-angle episiotomies would achieve a more accurate cutting angle of 60A degrees.

Angles were cut on episiotomy incision pads in a mounted birth model simulating crowning: 110 midwives and doctors cut an 60A degrees episiotomy with Mayo scissors and then EPISCISSORS-60. Angles were measured with protractors. Average angles were calculated and the one-tailed paired t test was used to compare groups.

Mean angle was 45A degrees with Mayo scissors [SD = 9, 95% confidence interval (CI) = 43.3-46.7, interquartile range (IQR) 38-50] and 60A degrees with the EPISCISSORS-60 (SD = 3, 95% CI = 59.3-60.7, IQR = 58-60). Two-thirds of cuts with Mayo scissors were below 50A degrees.

In a simulated setting the majority of operators are unable to cut an episiotomy at the recommended 60A degrees angle with Mayo scissors. The EPISCISSORS-60 cut an episiotomy a statistically significant 15A degrees wider than regular Mayo scissors and achieved the recommended 60A degrees in the vast majority of cases. If these findings translate into real life situations, then cutting episiotomies at 60A degrees is expected to make a valuable contribution in reducing third- and fourth-degree tears in both spontaneous and operative vaginal deliveries. Variability in mediolateral episiotomies should be reduced by use of fixed-angle scissors or through validated health professional training programmes to improve visual accuracy.