This document discusses episiotomy, including its definition as a surgically planned incision made during childbirth, purposes such as facilitating delivery and reducing perineal tearing, types (median, mediolateral, lateral), indications, advantages, repair process, post-operative care, and potential complications. The repair process involves suturing the vaginal mucosa, perineal muscles, and skin in layers to restore anatomical structure while controlling bleeding and preventing infection.
3. Definition
A surgically planned incision on
the perineum and the posterior
vaginal wall during the second
stage of labour is called
episiotomy.
4. Purpose
To enlarge the vaginal introitus
To facilitate easy & safe delivery
To minimize rupture of the perineal
muscles & facia.
To reduce stress on fetal head.
8. Advantages
Maternal Fetal
Easy to repair Minimizes
Reduction in intracranial
duration of labour
injuries esp. in
Reduction of
premature
trauma
babies
11. Medio lateral :
Begins at the midpoint of the
fourchette
Directed at a 45 degree angle to
the midline
Towards a point midway between
the ischial tuberosity & the anus.
12.
13. MERITS DEMERITS
MEDIAN
Safety from Apposition of
rectal tissue not so
involvement good
Incision can Discomfort is
be extend. more.
Wound
disruption is
more
14. Median :
Midline incision that follows
the natural line of insertion
of the perineal muscles.
15. Merits Demerits
Reduced blood Extension may
loss involve the
Easy to repair rectum
Lesser pain Damage to anal
sphincter
17. Equipments :
Sterile drape
Sterile gown and gloves
Gauze swabs and tampon
Needle holder
Sponge holder
Scissors ,10 ml syringe
Toothed forceps
Suture material
1% lignocaine
18. 1 :Preliminaries:
The perineum is thoroughly
swabbed with antiseptic lotion,
Draped properly,
Incision line- Infiltrated with 10 ml
of 1% lignocaine solution.
19. 2:Making Episiotomy
• Two fingers are placed in the
vagina between the presenting
part & posterior vaginal wall.
20. The incision is made by straight
or curved blunt pointed sharp
scissors
The open blades are positioned.
21. Incision should be made at the
height of an contraction.
Cut should be made starting from
the centre of the forchette
extendening laterally either to the
left or right.
22. It is directed diagonally in a
straight line which runs about 2.5
cm away from the anus.
23. If delivery of the head does not
follow immediately, apply pressure
to the episiotomy site.
Control delivery of the head to
avoid extension of the episiotomy.
27. Purpose of Repair
To control bleeding
To prevent infection
To assist wound healing by
primary intention.
28. The most common suture type
polyglactin 910 suture:
Coated Vicryl, Vicryl RAPIDE (> 70%)
polyglycolic acid:
Safil, Safil Quick, Dexon II (12%)
Traditional sutures :
catgut, chromic catgut) (10%).
29. Preliminaries :
The patient is placed in
lithotomy position
A good light source from behind
is needed to find the apex first.
30. The perineum &the wound area
is cleaned with antiseptics
Blood clots are removed from the
vagina & the wound area
31. The patient is drapped properly
&repair should be done under
strict aseptic precaution
A vaginal pack is inserted & is
placed high up.
33. Cotton balls must not be used.
Handle tissue gently using non
toothed forceps.
Ensure good anatomical restoration
and alignment to facilitate healing.
34. • Use minimal amount of suture
material, and do not over tighten suture
this may impede healing.
• Following the repair a rectal examination
should be performed to ensure no suture
material has been inserted through the
rectal mucosa.
37. Step 1 Suturing the vagina
• Identify the apex.
• Insert the anchoring suture 0.5 cm
above the apex.
• Repair the vaginal wall with a
continuous non-locking stitch with
approximately 0.5 cm between each
stitch.
38. Step 2 Suturing the perineal
muscle
Check the depth of the trauma.
Repair the perineal muscles in one or
two layers with the same continuous
stitch.
Ensure the muscle edges are apposed
carefully leaving no dead space.
39. On completion of the muscle
layer, the skin edges should align
so that they can be brought together
without tension.
40. Step 3 Suturing the skin
• Reposition the needle at the inferior
end of the wound commence.
• Stitches are placed below the surface
of the skin,
41. • The point of the needle should be
repositioned between each side,
• So that it faces the skin edge being
sutured.
• Continue taking bites of tissue from each
side until the superior wound edge is
reached.
42. Immediate care
• Inspect the repair to check that
haemostasis has been achieved
• Remove the vaginal tampon, if used,
• Account for all instruments, swabs and
needles
• Discard sharps safely
43. Apply sterile pad following thorough
perineal wash
Wait for minimum one hour to shift the
patient to ward
Check for bleeding & urine output
45. Health education
• Eat a diet high in fibre and fluids to
prevent constipation
• Ask the women to walk with thighs
apposed,
• not to use squatting position since the
wound is healing.
46. Perineal hygiene
Change sanitary pads at least every 4
hours to help prevent infection.
squirt warm tap water over the
perineum, beginning at the front and
moving toward the back .
47. • Sit in a tub of warm water
• Always wash hands thoroughly before
and after going to the bathroom.
• Always keep the wound clean & dry after
each urination & defecation.
48. kegal’s exercise
• Squeeze the perineal muscles as if
you were trying to stop the flow of
urine.
• Hold for 5 to 10 seconds and then
relax. Do this exercise 10 times a day
to regain muscle strength.