Episiotomy procedure

An episiotomy is a cut (incision) through the area between your vaginal opening and your anus. This area is called the perineum. This procedure is done to make your vaginal opening larger for childbirth.

1. Episiotomy Presented By :- Ms. Samiksha singh Bsc (n) Iv th year Era college of nursing Guided By:- Dr.Anjalatchi Muthukumaran Vice principal Era college of nursing

2. To study about :- Introduction Definition Objectives Indication Advantages Types of episiotomy Objectives

3. Enlisting equipments Preparation of patient Making episiotomy Complications After care Health education

4. Episiotomy , also known as  perineotomy It is a surgical incision of the  perineum  and the posterior vaginal wall generally done by a  midwife or  obstetrician Which  is usually performed during second stage of labor to quickly enlarge the opening for the baby to pass through Introduction

5. A surgically planned Incision on the perineum and posterior vaginal wall during the second stage of labor is called episiotomy An episiotomy is a cut (incision) through the area between your vaginal opening and your anus. This area is called the perineum. This procedure is done to make your vaginal opening larger for childbirth. Definition

6. To enlarge the vaginal introits so as to facilitate easy and safe delivery of the fetus To minimize overstretching and rupture Of the perineum muscle to reduce the stress and strain on the fetal head Objectives

7. Time of episiotomy

8. Large size baby indication

9. Preterm delivery

10. Shoulder dystocia

11. Malpresentation

12. Unable to respond to the instructions

13. 1. Maternal :- A clear and controlled incision is easy to repair and heals better than lacerated wound that might occur otherwise. Reduction in the duration of second stage ADVANTAGES

14. 2. Fetal:- Minimize intracranial injuries specially in premature babies Helps to conduct breech delivery

15. There are 4 types of episiotomy- Mediolateral Median Lateral J shaped Types of episiotomy

16. The incision commences from the center of the fourchette and extends along posteriorly along the midline for about 2.5cm Median:-

17. The incision is made downwards and outwards from the midpoint of the fourchette either to the right or to the left It is diagonally in a straight line which runs about 2.5 Cm away from thre anus Mediolateral :-

18. The incision starts from about 1cm away from the center of the fourchette and extends laterally It has drawbacks like chances of injury to the Bartholins duct Lateral:-

19. The incision begins in the center of the fourchette and directed along the midline for about 1.5cm and then directed downwards and outwards along 5 or 7 O’clock position to avoid anal sphincter This is not done widely J shaped episiotomy :-

20. Check doctor’s order Establish rapport with patient Ensure that women consents to the procedure Provide comfort to patient Explain in short about the procedure Preparation of patient

21. Ensure good lighting Check the equipment before starting the procedure Provide screening Preparation of environment

22. Preparation of articles

23. Kidney tray To collect the waste material Pair of gloves To prevent the infection Gauze swabs To wipe the blood Needle holder To hold the needle while suturing A clean tray containing

24. Sponge holder To hold the Gauze pieces ALLIS FORCEP To hold heavy tissue Artery forcep To control bleeding Lignocaine % Local anesthetic Catgut suture To repair the episiotomy Episiotomy Scissors For incision

25. 10 ml syringe For administration of anesthesia Adson forcep To provide hemostasis Sponge holder To hold the cervix to see if there is any cervical tear

26.   step:-1 Preliminaries: The perineum is thoroughly swabbed with antiseptic lotion, Draped properly, Incision line- Infiltrated with 10 ml of 1% lignocaine solution. Steps of episiotomy

27. Step :-2 Incision Two fingers are placed in vagina between the presenting part and the vaginal wall The incision is made by curved or straight blunt pointed sharp scissor or scalpel One blade of which is placed inside , in between the fingers and the posterior vaginal wall and the other on the skin

28. The incision should be made at a height of uterine contraction Deliberate cut should be made starting from the center of the fourchette extending laterally either to the right or to Left. It is directed diagonally in a straight line which runs about 2.5cm away from the anus

29. Posterior vaginal wall Superficial and deep transverse perineum muscle Fascia covering those muscles Transverse perineum branches of pudendal vessels and nerves Subcutaneous tissue and skin . Structures cut are

30. Step:-3 REPAIR Timing of repair:- soon after expulsion of placenta Preliminaries :- The patient is placed in lithotomy position A good light source Clean the perineum area and wound with antiseptic solution Remove the blood clots from vagina and wound area

31. The repair should be done under strict aseptic precautions The repair is done in three layers :- Vaginal mucosa and submucosal tissue Perineal muscles Skin and subcutaneous tissue

32. Bleeding. Tearing into the rectal tissues and anal sphincter muscle which controls the passing of stool. Swelling. Infection. Collection of blood in the perineal tissues. Pain during sex. Complications of episiotomy

33. Immediate care Inspect the repair to check hemostasis has been achieved Account for all instruments, swabs and needle Discard sharp needle safely After care

34. Apply Sterile pad following through perineal wash Wait for minimum one hour to shift patient to ward Check for bleeding and urine output

35. Post operative care Dressing Comfort Ambulance Removal of stitches

36. Eat a diet high in Fiber and fluid to prevent constipation Ask the women to walk with thigh apposed Not to use squatting position since wound is healing Change sanitary pad at least every 4 hours to help prevent infection Health education

37. Sit in a tub of warm water Always wash hands before and after going to bathroom Always keep the wound clean and dry after each urination and defecation