The incision angle of mediolateral episiotomy before delivery and after repair

ObjectiveTo assess the relevance of the suture angle when evaluating mediolateral episiotomy, and the safety of the accepted lower limit of 40° for the incision angle.MethodThe angles formed by the incision and suture lines with the midline were measured, and any perineal tear noted, in 50 consecutive women undergoing their first vaginal delivery.ResultsThe angles were significantly different (40° and 22.5°, respectively; P < 0.001). The only variable significantly linked to the difference was the timing of the episiotomy.ConclusionThe suture angle cannot currently be used to assess the adequacy of the incision angle; moreover, an incision angle of 40° is probably too acute to prevent potential sphincter damage.