“Of all the improvements in obstetrics in the past 20 years, this truly stands out for its simplicity and effectiveness”
Professor of Obstetrics, Dublin

Episcissors-60Overview

A mother’s life can be severely affected if she is among the 30,000 UK women a year who suffer obstetric anal sphincter injuries (OASIS) during childbirth. Many cases result from a misjudgment of the angle of surgical cuts during childbirth. With this device, Episcissors‑60, episiotomy angles are easy to assess and can transform outcomes for women – and save the NHS money.

Evidence shows an 18-50% reduction in OASIS in five UK hospitals with 20,000 annual births attributable only to Episcissors‑60.

Reducing OASIS helps address a significant unmet clinical need with direct annual costs to the NHS of £55 million. The costs are ultimately far higher as OASIS is a major cause of associated complications that cause significant discomfort and long-term health consequences to patients and can be a source of extensive compensation claims.

Episcissors‑60 are simple to use surgical scissors with a flexible guide-limb allowing the blades to be kept at a 60 degree angle, minimising the risk of OASIS.

The innovation is owned by the NHS – developed by Dharmesh Kapoor, consultant obstetrician and gynaecologist at the Royal Bournemouth Hospital and a director of Medinvent. Plymouth Hospitals NHS Trust owns the patent and the Department of Health is a stakeholder in Medinvent Ltd.

Challenge/problem identified

Each year 30,000 women across the UK suffer obstetric anal sphincter injuries (OASIS). This is often due to misjudging the angle of surgical cuts during childbirth. OASIS is a serious complication, and is the single most important cause of anal incontinence (AI) in women.

There is a clear unmet clinical need to reduce the incidence of OASIS and to protect young mothers from avoidable harm which can have a devastating impact on their lives.

  • The direct annual cost of OASIS to the NHS is £55 million.
  • Surgical repair and postoperative care cost £1,625 per case.
  • Increased re-admission rates for wound breakdown and sepsis.
  • 25% of women need caesarean section in the next pregnancy, costing the NHS £4.9m a year.
  • Faecal incontinence repair (with a poor success rate) is £1,289 per person.
  • Sacral nerve stimulation (recommended by NICE) costs £10,000.
  • The annual cost for pads, drugs and medical consultations is £2,542.

According to the NHSLA perineal trauma claims settlements led to payments over 10 years of £31 million.

Actions taken

Episcissors-60 remove the human error in estimating episiotomy angles during childbirth. They have a patented guide-limb that points towards the anus and allows the scissor blades to be kept at a 60 degree angle. The guide-limb is flexible which accommodates the spherical distension as the baby’s head pushes through.

As an NHS Innovation Accelerator (NIA) fellow Dharmesh has focused on:

  • Building the evidence base for Episcissors-60 in association with Croydon University Hospital
  • Raising awareness of OASIS (and Episcissors-60) through scientific learning events and exhibitions
  • Providing free samples to maternity units for trial and evaluation
  • Working with NHS England to secure a best practice tariff, or similar innovation tariff, for a 60-degree episiotomy
  • Partnering with the Department of Health so that Episcissors-60 are now available at
a discount on the NHS Supply Chain.

Episcissors-60 cost £384 and each pair has a five-year life span. Dharmesh projects that a hospital should have enough to cover 1% of births.

Impacts/outcomes

Episcissors-60 are a low cost innovation that offers substantial NHS cost savings whilst also transforming outcomes for thousands of mothers every year. They are now used in 15 UK hospitals including Liverpool Women’s, Wigan, Norfolk and Norwich, Royal Free, Barnet, UCLH, Frimley Park, Coventry, Northampton, West Middlesex.EPISCISSORS-60 (002)

  • 18-50% reductions in OASIS were demonstrated in five UK hospitals with 20,000 annual births attributable (Van Roon 2015, Ying Yiing 2016).
  • Results have shown a reduction in OASIS in instrumental births from 8.8% to 0.6% and in normal births down from 4.3% to 0%.
  • Royal Free and Barnet Hospitals showed 50% reduction of OASIS in normal births and 75% in instrumental births.
  • A NICE Medtech innovation briefing provides extensive information. It reports that one specialist commentator said midwives felt more confident in performing episiotomies and any repair was easier after using the Episcissors‑

Research by Van Roon et al also showed:

  • Most healthcare professionals achieved post-suturing episiotomy angles between 40degreesand 60degrees
  • A significant increase in episiotomies in the delivery of nulliparous women.
  • High rates of satisfaction among all users.

“I would not want to deliver in a London hospital that does not use the Episcissors-60.” 

Patient feedback

Plans for the future

Dharmesh is working to fulfill his ambition for all NHS hospitals to use the Episcissors-60 to improve the outcomes for women needing an episiotomy during labour and to see their widespread international use.

Which national clinical or policy priorities does this example address?

  • Funding and efficiency
  • Health and wellbeing
  • Care and Quality

Contact us for help and advice

Dharmesh Kapoor, Consultant obstetrician and Gynaecologist, Director, Medinvent
E: dharmesh.kapoor@medinvent.net

Rebekah Tailor, Communications and Engagement Manager, NHS Innovation Accelerator
E: rebekah.tailor@uclpartners.com