Episiotomy suture removal care

An episiotomy is a surgical procedure to widen the opening of the vagina during childbirth.

During labor, your perineum — the skin and muscles between your vagina and anus — will be numbed with a shot, if you haven't already been given an epidural.

Then, a small, straight incision will be made in the middle of the perineum.

Alternatively, the incision may be made at an angle — a cut that is less likely than a straight incision to tear through the anus, but may take longer to heal.

1. EPISIOTOMY SUTU R E /R E M O V A L / C A R E Presente d BY- Ms. Anshika Shukla B.sc Nursing 4 th Year Era’s College Of Nursing Guide d BY- Dr. Anjalatchi Vice Principal Era’s College Of Nursing

2. Content to be learned Introduction Definition Objective Indication Contra indication Advantages Disadvantages

3. Continued Types Equipments Steps of Episiotomy Repair steps Postoperative care Complications Summary Bibliography

4. INTRODUCTION Episiotomy is a surgical incision Of the perineum performed to widen the vaginal opening for the delivery of an infant .An Episiotomy is cut with scissor as the infant head is crowning .

5. D E F I N I T I O N A surgically planned incision on the perineum and the posterior vaginal wall during the second stage of labor is called Episiotomy (perineotomy).

6. OBJECTIVES To enlarge the vaginal introitus so as to facilitate easy and safe delivery of the fetus . To minimize over stretching and rupture of the perineal muscles to reduce the stress and strain on the fetal head.

7. INDICATIONS In elastic (rigid) perineum :- causing arrest or delay in descent of the presenting part as in elderly primigravidae Anticipating perineal tear :- big baby, face to pubis delivery, breech delivery, shoulder dystocia. Operative delivery :- forceps delivery Previous perineal surgery :- perineal reconstructive surgery.

8. COMMON INDICATIONS ARE Threatened perineal injury in primigravidae. Rigid perineum Forceps, breech occipitoposterior or face delivery.

9. CONTRAINDICATIONS Abnormalities of the perineum Inflammatory bowel disease Severe perineal scarring Perineal malformation

10. TIMING OF THE EPISIOTOMY Bulging thinned perineum during contraction just prior to crowning (when 3-4cm of head is visible) is the ideal time.

11. T Y P ES Mediolateral Median Lateral ‘J’ shaped

12. MEDIOLATERAL The incision is made downwards 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 MEDIAN The incision commences from the centre of the fourchette and extends posteriorly along the midline for about 2.5cm .

13. L A T E RAL The incision starts from about 1cm away from the center of the fourchette and extends laterally. It has got many drawbacks including chance of injury to the bartholins duct. J SHAPED .The incision begins in the center of the fourchette and is directed posteriorly along the midline for about 1.5cm and then directed downwards and outwards along 5 or 7 O ‘ clock position to avoid the anal sphincter.

14. ADVANTAGES Maternal :- A clear and controlled incision is easy to repair and heals better than a lacerated wound that might occur otherwise. Reduction in the duration of second stage. Reduction of trauma to the pelvic floor muscles Fetal :- It minimizes intracranial injuries specially in premature babies or aftercoming head of breech.

15. DISADVANTAGE OF EPISIOTOMY Blood loss Difficulty during suturing Painful and discomfortable postpartum period Dyspareunia

16. ARTICLES Episiotomy scissors Surgical drape Needle holder. Stitches Tissue forcep Syringe Vulsellum Kidney tray Local anesthesia

17. PREPARATION OF THE PATIENT Preparation of Patient: 1. Explain procedure to the patient. 2. Provide privacy by screens and drapes. Drape the patient as for vaginal examinations. 3. Remove all articles that may interfere with the procedure e.g. air cushion. 4. Give extra pillows to raise the head. 5. Roll the draw sheet to opposite side to prevent soiling when bedpan is placed under buttocks, over draw sheet.

18. Continued 6. Offer bed pan. Keep the clean bed-pan on the bed on your working side. 7. Untie the pads, if any and observe the discharges its color, odor, amount etc. 8. Leave the patient for sometime so that she may pass urine or stool if necessary. 9. Get the toilet tray and arrange the articles conveniently on bed side table.

19. STEPS OF EPISIOTOMY Provide emotional support and encouragement Use local infiltration with lignocaine Make sure there are no known allergies to lignocaine or related drugs

20. C O N T… Apply ice packs right after the birth Using ice packs in the first 24 hours after birth decreases the swelling and and helps with pain Take warm baths but wait until 24 hrs after giving birth Make sure that the bathtub is cleaned with a disinfectant before every bath

21. SUMMARY Episiotomy is an incision in the perineum carried out during the second stage of labor to facilitate the birth of an infant .It is an important surgical procedure with physiological,psychological,and socio-economic effects on women.

22. BIBLIOGRAPHY DC Dutta’s Textbook of obstetrics, Hiralal konar . Midwifery and obstetrical nursing by Sandeep kaur . J. Myles ‘the textbook of midwifery 16 th edition . Https://:www.Slide share. Net .com .Https://:medlineplus.gov.