Episiotomy pkg

This contain is about episiotomy. this will help in OBG.

1. EPISIOTOMY PRESETED BY PRAVEEN KUMAR GHANCHI Principal, Aravalli school of nursing , Juna takhatpur

2. EPISIOTOMY INTRODUCTION:- Episiotomy is a surgical incision of the perineum that is made to prevent tearing of the perineum and to release pressure on the fetal head with birth. praveen kumar ghanchi

3. DEFINITION A surgically planned incision on the perineum and the posterior vaginal wall during the second stage of labour is called episiotomy ( perineotomy ). praveen kumar ghanchi

4. OBJECTIVES To enlarge the vaginal introitus so as to facilitate easy and safe delivery of the fetus – spontaneous or manipulative. To minimise overstretching and rupture of the perineal muscles and fascia; to reduce the stress and strain on the fetal head. praveen kumar ghanchi

5. INDICATION In elastic (rigid ) perineum :- Causing arrest or delay in descent of the presenting part as in elderly primigravidae . Anticipating perineal tear :- A] big baby B] face to pubis delivery C] breech delivery D] shoulder dystocia Operative delivery :- Forceps delivery , Ventous delivery . praveen kumar ghanchi

6. Conti…. Previous perineal surgery :- Pelvic floor repair , perineal reconstructive surgery. Fetal interest :- 1. fetal distress 2. premature baby 3. breech delivery Common indication are :- 1. threatened perineal injury in primigravidae 2.rigid perineum 3. forceps , breech, occipito -posterior or face delivery. praveen kumar ghanchi

7. ADVANTAGES MATERNAL A] a clear and controlled incision is easy to repair and heal batter than a lacerated wound. B] reduction in the duration of second stage c] reduction of trauma to the pelvic floor muscle – that reduces the incidence of prolapse and perhaps urinary incontinence. praveen kumar ghanchi

8. Conti.. FETAL ;- It minimise intracranial injuries specially in premature babies or after-coming head of breech. praveen kumar ghanchi

9. Timing of episiotomy Bulging thinned perineum during contraction just prior to crowning is the ideal time. praveen kumar ghanchi

10. Types of episiotomy medio -lateral Median Lateral J’ shaped praveen kumar ghanchi

11. Conti.. Medio -lateral The incision is made dounward and outwards from the midpoint of the fourchette either to the right or left. It is directed diagonally in a straight line which runs about 2.5 cm away from the anus. praveen kumar ghanchi

12. Conti.. Median The incision commences from the centre of the fourchette and extends posteriorly along the midline for about 2.5cm. lateral the incision start from about 1cm away from the centre of the fourchette and extends laterally. “J” shaped The incision begins in the centre of the fourchette and is directed posteriorly along the midline for about 1.5cm and then directed dounwards and outwards along 5or 7 O’ clock position to avoid the anal sphincter. praveen kumar ghanchi

13. STEPS OF MEDIOLATERAL EPISIOTOMY STEP- 1 preliminaries- the perineum is thoroughly swabbed with antiseptic ( povidone -iodine)lotion and draped properly. Local anaesthesia – the perineum, in the line of proposed incision is infiltration with 10 ml of 1% solution of lignocain . praveen kumar ghanchi

14. Conti… STEP- 2 incision :- two fingers are placed in the vagina between the presenting part and the posterior vaginal wall. The incision is made by a curved or straight blunt pointed sharp scissors ( scalpel may also be used ), one blade of which is placed inside, in between the fingers and the posterior vaginal wall and the other on the skin. The incision should be made at the height of an uterine contraction when an accurate idea of the extend of incision can be better judged from the stretched perineum. praveen kumar ghanchi

15. Conti.. Delibrate cut should be made starting from the centre of the fourchette extending laterlly either to the right or to the left. It is directed diagonally in a straight line which runs about 2.5cm away from the anus. The incisio ought to be adequate to serve the purpose of which it is needed. i.e. according to the individual case. The bleeding is usually not sufficient to use artery forceps unless the operation is done too early or the perineum is thick. praveen kumar ghanchi

16. Conti… STRUCTURE CUT ARE 1. posterior vaginal wall 2. superficial and deep transverse perineal muscles bulbospongiosus and part of levater ani . 3. fascia covering those muscles 4. transverse perineal branches of pudendal vessels and nerves 5.subcutaneous tissue and skin praveen kumar ghanchi

17. STEPS -3 Repair ;- the repair is done soon after expulsion of placenta . praveen kumar ghanchi

18. Preliminaries The patient is in lithotomy position. A good light source from behind is needed. The perineum including the wound area is cleaned with antiseptic solution. Blood clots are removed from the vagina and the wound area. The patient is draped and repair should be done under strict aseptic precaution. praveen kumar ghanchi

19. The repair is done in three layers. The principles to be followed are Perfect haemostasis To obliterate the dead space Suture withouht tension. The repair is done in following order : 1.Vaginal mucosa and submucosal tissues 2.Perineal muscles 3.skin and subcutaneous tissues. praveen kumar ghanchi

20. POST OPERATIVE CARE Dressing :- The wound is to be dressed each time following urination and defeacation to keepthe area clean and dry . The dressing is done by swabbing with cotton swabs soaked in antiseptic solution followed by application of antiseptic powderor ointment . Comfort :- Torelieve pain in the area, application of heat and cold, sitz bath may be used. Analgesic drugs (aspirin} may be given as and when required. praveen kumar ghanchi

21. COMPLICATIONS Immediate Remote 1) Immediate Extension of the incision to involve the rectum Vulval haemetoma Infection Wound dehiscene is often due to infection, haematoma or faulty repair. 2) Remote Dyspareunia Chance of perineal lacerations Scar endometriosis praveen kumar ghanchi

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