Critical Appraisal for Therapy Articles RATU ASTUTI DWI PUTRI

Step 1

Patient primiparous women, singleton term pregnancy and vertex presentation of

occiput anterior position fetus (included criteria) in labor
Intervention mediolateral episiotomy
Comparison 1) cut by Braun Stadler angled scissors
2) cut by Curved Mayo scissors
3) cut by Straight scissors
Outcome decrease risk of incidence Obstetric anal sphincter injury (OASIS)

Formulation Question :
Was is cutting mediolateral episiotomy used any type of Scissors (Braun Stadler Angle,
Curved Mayo or Straight) decrease risk of incidence Obstetric anal sphincter injury
(OASIS) ?

Step 2
“Impact of Scissors Type Used for Episiotomy on the Prevalence of Obstetric Anal Sphincter
Injury: Randomised Controlled Trial”

Are the result of this study valid?

Question Answer
Was a qualitative approach appropriate? YES
The trial tried to compare between the prevalence of obstetric anal sphincter injury
(OASIS) after cutting mediolateral episiotomy by angled, curved or straight scissors in
women in labour

Was the sampling strategy appropriate for the approach? YES

All patients in this study used randomized controlled trial (RCT) method
Were the groups similar at the start of the trial? YES
All groups were already tried to design similar (as show in Demographic characteristics of
the three study groups (table 1), but I think they didn’t add other essential part that
correlation with primary outcome
Aside from the allocated treatment, were groups treated equally? YES
They treated three groups equally, they did not do any additional treatment for any group
Were all patients who entered the trial accounted for? And were they YES
analysed in the groups to which they were randomised?

Due to this research was all of participant accounted until the end. The patient that
accounted for this trial was picked based from the inclusion and exclusion criteria and
was randomized into either treatment group and control group.

Were measures objective or were the patients and clinicians kept NO

“blind” to which treatment was being received?
Double blinding is difficult because the observer will see the used scissor during cutting
BUT outcomes are objective and unlikely to be biased by lack of blind

Were the population group appropriate for the study and the YES
outcomes?
Due to no missing data in characteristic of the three group in current paper, we can
determine that all the group appropriate for the study and the outcomes

Research Journal of Obstetrics and Gynecology

Critical Appraisal for Therapy Articles RATU ASTUTI DWI PUTRI

WHAT IS THE RESULT?

1. How large was the treatment effect?

 Based on statistical analysis, the intervention effect applied in this study (RR,
0.33; 95% CI, 0.13 to 0.88; p-value;.027) with a number needed to treat (NNT)
of 10 (95% CI, 5.5 to 55.5). as shown in table 8
 showed that Type A (angle Braun Stadler scissors) were associated with
significantly lower risk for OASIS

2. How precise was the estimate of the treatment effect?

 The author use the baseline of 95% Confidence interval which count as minimal
confidence limit and the significance limit is also standard

3. How Can the results be applied? (Applicability/Validity)

 The result of this finding can be applied immediately to our hospital by do
mediolateral episiotomy by Braun Stadler angled scissors.
 But some caution should be performed because this study was a RCT in design.
Further meta-analysis may be needed until implementation of this finding

Research Journal of Obstetrics and Gynecology