{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T22:54:50Z","timestamp":1790722490650,"version":"4.1.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2021,11,16]],"date-time":"2021-11-16T00:00:00Z","timestamp":1637020800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"},{"start":{"date-parts":[[2021,11,16]],"date-time":"2021-11-16T00:00:00Z","timestamp":1637020800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"funder":[{"DOI":"10.13039\/100010377","name":"National Institute for Health and Care Excellence","doi-asserted-by":"publisher","award":["External Assessment Centre contract"],"award-info":[{"award-number":["External Assessment Centre contract"]}],"id":[{"id":"10.13039\/100010377","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Appl Health Econ Health Policy"],"published-print":{"date-parts":[[2022,3]]},"DOI":"10.1007\/s40258-021-00695-9","type":"journal-article","created":{"date-parts":[[2021,11,16]],"date-time":"2021-11-16T04:35:11Z","timestamp":1637037311000},"page":"159-169","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Episcissors-60 for Mediolateral Episiotomy: Evaluation of Clinical and Economic Evidence to Inform NICE Medical Technologies Guidance"],"prefix":"10.1007","volume":"20","author":[{"given":"Susan","family":"O\u2019Connell","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Dale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Morgan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernice","family":"Dillon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0431-3138","authenticated-orcid":false,"given":"Andrew","family":"Cleves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhys","family":"Morris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Carolan-Rees","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,11,16]]},"reference":[{"issue":"5","key":"695_CR1","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1007\/BF03261863","volume":"10","author":"B Campbell","year":"2012","unstructured":"Campbell B, Campbell M. NICE medical technologies guidance: a novel and rigorous methodology to address a new health technology assessment challenge. Appl Health Econ Health Policy. 2012;10(5):295\u20137.","journal-title":"Appl Health Econ Health Policy"},{"key":"695_CR2","unstructured":"O\u2019Connell S, Morgan H, Carolan-Rees G. MT457 Episcissors-60 for guided mediolateral episiotomy (external assessment report). 2019. Available at: https:\/\/www.nice.org.uk\/guidance\/mtg47\/documents\/supporting-documentation. Accessed 14 Jan 2020."},{"key":"695_CR3","unstructured":"National Institute for Health and Care Excellence. Episcissors-60 for mediolateral episiotomy [MTG47]. National Institute for Health and Care Excellence; 2020. Available at: https:\/\/www.nice.org.uk\/guidance\/mtg47. Last accessed 14 Jan 2020."},{"issue":"12","key":"695_CR4","doi-asserted-by":"publisher","first-page":"1621","DOI":"10.1007\/s00192-014-2406-x","volume":"25","author":"G Thiagamoorthy","year":"2014","unstructured":"Thiagamoorthy G, Johnson A, Thakar R, Sultan AH. National survey of perineal trauma and its subsequent management in the United Kingdom. Int Urogynecol J. 2014;25(12):1621\u20137.","journal-title":"Int Urogynecol J"},{"key":"695_CR5","unstructured":"National Institute for Health and Care Excellence. Intrapartum care for healthy women and babies [CG190]. National Institute for Health and Care Excellence; 2017. Available at: https:\/\/www.nice.org.uk\/guidance\/cg190. Last accessed 14 May\u00a02020."},{"issue":"12","key":"695_CR6","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1111\/j.1471-0528.2003.03030.x","volume":"110","author":"DG Tincello","year":"2003","unstructured":"Tincello DG, Williams A, Fowler GE, Adams EJ, Richmond DH, Alfirevic Z. Differences in episiotomy technique between midwives and doctors. BJOG Int J Obstet Gynaecol. 2003;110(12):1041\u20134.","journal-title":"BJOG Int J Obstet Gynaecol"},{"key":"695_CR7","unstructured":"NMPA Project Team. National Maternity and Perinatal Audit: Clinical Report 2019. Based on births in NHS maternity services between 1 April 2016 and 31 March 2017. London: RCOG; 2019. Available at: https:\/\/maternityaudit.org.uk\/filesUploaded\/NMPA%20Clinical%20Report%202019.pdf. Last accessed 07 May 2021."},{"issue":"10","key":"695_CR8","doi-asserted-by":"publisher","first-page":"1459","DOI":"10.1007\/s00192-016-2956-1","volume":"27","author":"TS Verghese","year":"2016","unstructured":"Verghese TS, Champaneria R, Kapoor DS, Latthe PM. Obstetric anal sphincter injuries after episiotomy: systematic review and meta-analysis. Int Urogynecol J. 2016;27(10):1459\u201367.","journal-title":"Int Urogynecol J"},{"key":"695_CR9","volume-title":"National maternity and perinatal audit: clinical report 2017","author":"NMPA Project Team","year":"2018","unstructured":"NMPA Project Team. National maternity and perinatal audit: clinical report 2017. RCOG London; 2018."},{"issue":"2","key":"695_CR10","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1097\/AOG.0000000000002444","volume":"131","author":"O Ramm","year":"2018","unstructured":"Ramm O, Woo VG, Hung YY, Chen HC, Weintraub MLR. Risk factors for the development of obstetric anal sphincter injuries in modern obstetric practice. Obstet Gynecol. 2018;131(2):290\u20136.","journal-title":"Obstet Gynecol"},{"issue":"3","key":"695_CR11","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1111\/aogs.12557","volume":"94","author":"M Davies-Tuck","year":"2015","unstructured":"Davies-Tuck M, Biro MA, Mockler J, Stewart L, Wallace EM, East C. Maternal Asian ethnicity and the risk of anal sphincter injury. Acta Obstet Gynecol Scand. 2015;94(3):308\u201315.","journal-title":"Acta Obstet Gynecol Scand"},{"key":"695_CR12","first-page":"23","volume":"7","author":"RM Freeman","year":"2014","unstructured":"Freeman RM, Hollands HJ, Barron LF, Kapoor DS. Cutting a mediolateral episiotomy at the correct angle: evaluation of a new device, the Episcissors-60. Med Devices Evid Res. 2014;7:23\u20138.","journal-title":"Med Devices Evid Res"},{"key":"695_CR13","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.ejogrb.2018.03.021","volume":"224","author":"H Mohiudin","year":"2018","unstructured":"Mohiudin H, Ali S, Pisal PN, Villar R. Implementation of the RCOG guidelines for prevention of obstetric anal sphincter injuries (OASI) at two London Hospitals: a time series analysis. Eur J Obstet Gynecol Reprod Biol. 2018;224:89\u201392.","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"695_CR14","doi-asserted-by":"publisher","first-page":"253","DOI":"10.2147\/MDER.S66901","volume":"7","author":"RP Patel","year":"2014","unstructured":"Patel RP, Ubale SM. Evaluation of the angled Episcissors-60() episiotomy scissors in spontaneous vaginal deliveries. Med Devices Evid Res. 2014;7:253\u20136.","journal-title":"Med Devices Evid Res"},{"key":"695_CR15","doi-asserted-by":"publisher","first-page":"251","DOI":"10.2147\/MDER.S83360","volume":"8","author":"G Sawant","year":"2015","unstructured":"Sawant G, Kumar D. Randomized trial comparing episiotomies with Braun-Stadler episiotomy scissors and EPISCISSORS-60(). Med Devices Evid Res. 2015;8:251\u20134.","journal-title":"Med Devices Evid Res."},{"key":"695_CR16","doi-asserted-by":"publisher","first-page":"949","DOI":"10.2147\/IJWH.S94680","volume":"7","author":"Y van Roon","year":"2015","unstructured":"van Roon Y, Kirwin C, Rahman N, Vinayakarao L, Melson L, Kester N, et al. Comparison of obstetric anal sphincter injuries in nulliparous women before and after introduction of the EPISCISSORS-60 at two hospitals in the United Kingdom. Int J Women\u2019s Health. 2015;7:949\u201355.","journal-title":"Int J Women's Health"},{"key":"695_CR17","doi-asserted-by":"crossref","unstructured":"Ayuk P, Robson S, Farnworth A, Rees J, Khunda A. Obstetric anal sphincter injuries (OASIs) before and after the introduction of the Episcissors-60: a multi-centre time series analysis. 2018. (Unpublished work).","DOI":"10.1016\/j.ejogrb.2019.08.016"},{"issue":"Supplement 3","key":"695_CR18","first-page":"44","volume":"125","author":"A Condell","year":"2018","unstructured":"Condell A, Bulchandani S, Burden F. Episcissors-reducing obstetric anal sphincter injuries (OASI) in instrumental delivery. BJOG Int J Obstet Gynaecol. 2018;125(Supplement 3):44.","journal-title":"BJOG Int J Obstet Gynaecol."},{"key":"695_CR19","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1111\/1471-0528.15635","volume":"126","author":"A Farnworth","year":"2019","unstructured":"Farnworth A, Ayuk P, Robson S. A pragmatic evaluation of barriers and facilitators to the implementation of an obstetric innovation (Episcissors) across maternity units in the North East and North Cumbria. Labour and Delivery. BJOG: Int J Obstet Gy. 2019;126:87\u2013114. https:\/\/doi.org\/10.1111\/1471-0528.15635.","journal-title":"BJOG: Int J Obstet Gy"},{"issue":"Supplement 2","key":"695_CR20","first-page":"51","volume":"123","author":"YY Lou","year":"2016","unstructured":"Lou YY, Thakar R, Sultan AH, Ajay B. Does Episcissors-60 reduce the incidence of obstetric anal sphincter injuries (OASI)? BJOG Int J Obstet Gynaecol. 2016;123(Supplement 2):51.","journal-title":"BJOG Int J Obstet Gynaecol."},{"key":"695_CR21","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.ejogrb.2019.08.016","volume":"241","author":"P Ayuk","year":"2019","unstructured":"Ayuk P, Farnworth A, Rees J, Khunda A, Edmundson D, Raheja V, Ullal A, Ravimohan V, Lu E, Robson SC. Obstetric anal sphincter injuries before and after the introduction of the Episcissors-60: a multi-centre time series analysis. Eur J Obstet Gynecol Reprod Biol. 2019;241:94\u20138.","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"695_CR22","unstructured":"GRADEpro GDT: GRADEpro Guideline Development Tool [Software]. McMaster University, 2015 (developed by Evidence Prime, Inc.). Available from http:\/\/www.gradepro.org. Last accessed 22 July 2021."},{"key":"695_CR23","unstructured":"Cochrane Review Manager software version 5.4.1 (September 2020). Available at: https:\/\/training.cochrane.org\/online-learning\/core-software-cochrane-reviews\/revman\/revman-5-download. Last accessed 22 July 2021."},{"key":"695_CR24","unstructured":"York Health Economics Consortium (2017). Economic impact evaluation case study: Episcissors-60. Available at: https:\/\/www.medinvent.co.uk\/assets\/episcissors-economic-case-study-yhec-august-2017.pdf."},{"key":"695_CR25","unstructured":"NHS Improvement (2020). Reference cost collection: National Schedule of Reference Costs\u2014Year 2017\u201318\u2014NHS trust and NHS foundation trusts. NZ27Z post-natal therapeutic procedures. Available at: https:\/\/webarchive.nationalarchives.gov.uk\/20200501111106\/https:\/\/improvement.nhs.uk\/resources\/reference-costs\/. Last accessed 14 May 2021."},{"key":"695_CR26","unstructured":"Royal College of Obstetricians and Gynaecologists (2015) The management of third and fourth degree perineal tears. Green-top guideline 29. Available at: https:\/\/www.rcog.org.uk\/en\/guidelines-research-services\/guidelines\/gtg29\/. Last accessed: 14 May 2021."},{"key":"695_CR27","unstructured":"OASI Care Bundle Project Team. Implementation guide for maternity sites in the roll-out phase 2017\u20132018. RCOG London; 2018. Available at: https:\/\/www.rcog.org.uk\/globalassets\/documents\/guidelines\/research--audit\/oasi-care-bundle\/oasi-care-bundle-guide-final-_-050118.pdf. Last accessed: 28 June 2021."}],"container-title":["Applied Health Economics and Health Policy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40258-021-00695-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s40258-021-00695-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40258-021-00695-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,16]],"date-time":"2022-02-16T04:54:04Z","timestamp":1644987244000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s40258-021-00695-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,16]]},"references-count":27,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2022,3]]}},"alternative-id":["695"],"URL":"https:\/\/doi.org\/10.1007\/s40258-021-00695-9","relation":{},"ISSN":["1175-5652","1179-1896"],"issn-type":[{"value":"1175-5652","type":"print"},{"value":"1179-1896","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,16]]},"assertion":[{"value":"21 October 2021","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 November 2021","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"SO, MD, HM, AC, RM, BD and GC-R contributed to the preparation of this manuscript. GC-R reviewed the full assessment report as well as this article. RM reviewed the article and can act as a guarantor for the overall content.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Author contributions"}},{"value":"Susan O\u2019Connell, Megan Dale, Andrew Cleves and Rhys Morris and are employees of the NHS and Grace Carolan-Rees was an employee of the NHS until September 2020, which has a financial interest in the guidance on which this project is based. Helen Morgan is a Cardiff University employee and has no conflicts of interest to declare. Bernice Dillon is a NICE employee and had no role in the production of the assessment report but contributed to the preparation of this manuscript. This summary of the Medical Technology Guidance was produced following the publication of the final guidance report. The article has not been externally peer reviewed by Applied Health Economics and Health Policy, but has been reviewed externally by NICE. Cedar was funded by the NICE Medical Technologies Evaluation Programme for its work.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}}]}}