Episiotomy.pptx

Episiotomy and its types

1. Episiotomy Lt.Col . Dr.Rosy Malla

2. Definition A surgically planned incision on the perineum and the posterior vaginal wall during the second stage of labor

3. Objective Facilitate easy and safe delivery of the fetus Reduce stress and the strain on fetus head

4. Indications Rigid perineum Big baby,breech delivery,shoulder dystocia,face to pubis delivery Operative delivery- forceps,vacuum delivery Previous perineal surgery

5. Timing of the episiotomy Bulging thinned perineum during contraction just prior to crowning

6. Advantages of episiotomy Maternal advantages Clean and controlled incision which is easy to repair and heal Reduction in the duration of second stage of labor Reduction of trauma to pelvic floor muscles Fetal Advantages Minimises intracranial injuries especially premature babies and after coming head of breech

7. Medialateral episiotomy Merits Safety from rectal involvement Incision can be extented Demerits Apposition of tissues is not so good Postoperative discomfort Wound disruption Dyspareunia

8. Median episiotomy Merits Reduced blood loss Easy to repair Healing is better Dyspareunia is rare Postoperative pain is minimal Wound disruption is rare Demerits Extension may involve the rectum May involve anal sphincter

9. Steps Perineum swabbed with antiseptic lotion Local anaesthesia in the line of proposed incision with 1%lignocaine Two fingers are placed in vagina between the presenting part and the posterior vaginal wall Incision is made at the height of uterine contraction-starting from the centre of fourchette extending lateral 2.5cm away from anus

10. Structures involved Posterior vaginal wall Superficial and deep perineal muscles Fascia covering these muscles Transverse perineal branch of pudendal nerves and vessels Subcutaneous tissue and skin

11. Principles of repair Close all dead space –ensure hemostasis and prevent infection Repair without tension in three layers afterexpulsion of placenta

12. Layers of perineal repair Vaginal mucosa and submucosa Perineal muscles Skin and subcutaneous tissue

13. Layers of perineal repair

14. Step1 Suturing the vagina Identify the apex Insert the anchoring suture 0.5cm above the apex Repair the vaginal wall with a continuous non locking suture

15. Step2 Suturing the perineal muscles Check the depth of trauma Repair the perineal muscles with continuous suture Ensure the muscle edges are apposed carefully without leaving dead space

16. Step3 Suturing the skin Sitches are placed below the surface of the skin

17. Complications Immediate Extension to rectum Vulval hematoma Infection Injury to anal spinchter Wound dehiscence Late Dyspareunia Scar endometriosis

18. Perineal hygiene Sit in a tub of warm water Always keep the wound clean and dry after each urination and defecation Change pad every 4 hours