Episiotomy Definition

EPISIOTOMY
Definition:
Episiotomy is a planned surgical incision made on the perineum and posterior
vaginal wall during late second stage to facilitate delivery.
Indication:
1. All primigravidae and nulliparous
2. Instrumental vaginal delivery, obstetric forceps, vacuum extraction.
3. Preterm foetus to decrease trauma to foetal head
4. Rigid Perineum
5. History of gynecological operations in the past
- Colpoperineorrhaphy
- Repair of third degree perineal tear
6. Anticipated perineal tear
7. To cut short the second stage of labour in case where each bearing down effort
even to overcome the tissue resistance entails risk to mother or the fetus. These
may be
- Heart disease
- Severe pre-eclampsia
- Post- caesarean cases
- Post maturity
- Cord prolapse in second stage of labour
- Fetal distress in second stage of labour
Types of episiotomy:
1. Mediolateral
2. Median
3. Lateral
4. J-shaped
Purposes:
1. Saves perineum from laceration, hematoma and complete perineal tear.

2. To cut short the second stage of labour.
3. To substitute a straight surgical incision for the laceration that may otherwise
occur.
4. to speed delivery if there is fetal distress.
5. To minimize the risk of intracranial damage during pre-term and breech delivery
6. To prevent overstretching of the perineal muscles.
Articles:
A sterile tray containing
- Sterile syringe with needle
- Needle holder -1
- Episiotomy scissors
- Suture cutting scissors
- Round body catgut 2-0
- Thumb forceps
- Toothed thumb forceps
- Kidney tray
- Lignocaine 2%
- Antiseptic solution
- Sterile gloves
- Gauze piece
- Tampon/ Vaginal pack/ pads
General Instructions:
1. Ensure that;
a) The presenting part is directly applied to the perineal tissues, which will be
evidenced as bulging perineum .
b) Vaginal orifice is distended by approximately 3cm diameter of presenting part
between contractions
2. The presenting part of the fetus should be protected from injury.
3. A single cut in any direction is preferable to repeated snipping, as the latter will
have jagged ends.
4. The episiotomy should be large enough to meet the purpose.
5. The timing of the cut should be such that laceration prevented and unecessary
blood loss avoided.
Procedure
1. Place the patient on the delivery table in dorsal recumbent position when the
fetal head is distending the perineum.
2. Infiltrate the perineum using 10ml local anesthesia ( inj Lignocaine 2%) . Wait
for 3-5 min for it to act.
3. Place your index and middle finger in the vagina with palmer side down and
facing you. Separate them slightly and exert outward pressure on the perineal
body.
4. Place the blades of the scissors in a straight up and down position, so that one
blade is against the posterior vaginal wall and the other blade is against the skin of
the perineal body with the point where the blades cross at the middle of the
posterior fourchette.
5. Adjust the length of the blades of the scissors on the perineal body and predict
the length of the incision accordingly.
6. a) A mediolateral is a cut at a slant, starting at the midline of the fourchette with
the points of the scissors directed toward the ischial tuberosity on the same side as
the incision.
b) A midline episiotomy is cut in the middle of the central tendinous points of
the perineum from the posterior fourchette down to the external anal sphincter. The
ideal timing of episiotomy is a bulging thin perineum at the peak of a contraction
just prior to crowning.
7. If a midline episiotomy was cut, palpate for the external anal sphincter.
8. Cut again if needed, avoid snipping.
9. Extend the vaginal side of the incision if needed by incising the vaginal band .
For this, the scissors must come from above the backside of the hand to slide down
the fingers and make the cut.
10. Apply pressure with sterile pads / gauze.
11. after completion of delivery assist for suturing of episiotomy incision.
12. Wipe the wound area with sterile antiseptic swabs.
13. Focus light on the perineal area.
14. Diagnose the degree of peineal tear if any.
15. Pack the vagina with plug or tampons.
16. Visualize the apex of the mucosa, start suturing little above the apex. Appose
the vaginal tear by continuous suture using a round body needle.
17. Repair the perineal muscles by interrupted sutures; include the deeper tissue to
enclose dead space.
18. Perineal skin is apposed by mattress suture.
19. Remove the vaginal pack which was inserted during suturing.
20. Clean the perineum and apply pads.
21. Straighten patient’s legs and assist her to supine position with legs crossed.
22. Wash and dry the instruments used for episiotomy along with those used for
conduct of delivery and suturing.
23. Record in the labour record, the time episiotomy was performed, type of
episiotomy, suturing carried out and patient’s reaction.
After Care
1. Check for any bleeding from the inner areas or hematoma formation.
2. Check vital Signs.
3. Check for any other tear or laceration.
Complications
1. Hematoma
2. Infection
3. Wound infection
4. Perineal laceration.
5. Dysperunia
6. Scar endometriosis

Episiotomy Definition

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Episiotomy Definition

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EPISIOTOMY

1. Saves perineum from laceration, hematoma and complete perineal tear.

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