Episiotomy

obstetrical condition

1. TOPIC ON EPISIOTOMY

2. Definition
A surgically planned incision on the
perineum and the posterior vaginal wall during
the second stage of labour is called episiotomy.

3. OBJECTIVES
•To enlarge the vaginal introitus
•To minimize overstretching and rupture of the
perineal muscles and fascia.
•To reduce the stress and strain on the fetal head.

4. INDICATIONS
• Primigravidae as on elective procedure
• Face to pubis delivery
• Big baby
• Narrow pelvic arch
• Elderly primigravida
• Old perineal scar of episiotomy or perineorrhaphy
• Manipulative delivery – forceps, breech etc
• To cut short the second stage cases such as pre-eclampsia.
• Fetal distress, premature baby

5. TIMING OF EPISIOTOMY
Bulging thinned perineum during contraction.
Just prior to crowning.

6. Advantages
•Maternal
•Fetal

7. Anatomy of the pelvic floor

8. Step I
• Cleaning of the perineum
• Draping
• Local anaesthesia

9. Step II
Incision
Structures cut are
•Posterior vaginal wall
•Superficial and deep transverse perineal muscles
(bulbospongiosus and part of levator ani)
•Fascia covering those muscles
•Transverse perineal branches of pudendal vessels and
nerves
•Subcutaneous tissue
•Skin

10. Step III
Repair
• Vagina mucosa and submucosal tissues
• Perineal muscles
• Skin and subcutaneous tissue

11. Requirements for episiotomy
• Good light source
• Linen and dressing
• Instruments
• Sutures and needles

12. COMPLICATIONS
Immediate:
Extension of the incision
Vulval haematoma
Infection
 Wound dehiscence
Remote:
Dyspareunia

13. Post operative care
 Dressing
 Comfort
 Ambulate
 Removal of stitches

14. CONCLUSION
Definition
Objectives
Indications
Timing of episiotomy
Advantages
Types
Steps
Complications
Post operative care