Episiotomy suturing.pptx

Maternal Nursing

1. Episiotomy suturing By supriya batwalkar 27-11-2017 I msc nursing 1

2. DEFINITION A surgically planned incision on the perineum and the posterior vaginal wall during the second stage of labor is called episiotomy or perineotomy . 27-11-2017 I msc nursing 2

3. OBJECTIVE To cut short the second stage of labor. To enlarge introitus (vaginal opening) in order to facilitate easy delivery of baby. To minimize over stretching and rupture of vagina, perineal muscles and fascia. To reduce stress on fetal head. 27-11-2017 I msc nursing 3

4. INDICATIONS In elastic (rigid) perineum. Anticipating perineal tear. Operative delivery Previous perineal surgery. Threatened perineal injury in primi gravidae . 27-11-2017 I msc nursing 4

5. TIMING OF EPISIOTOMY Bulging thinned perineum during contraction just prior to crowning (when 3-4 cm of head is visible) is the ideal time. If done early- chances of blood loss. If done late – fails to prevent the invisible lacerations of perineal body. 27-11-2017 I msc nursing 5

6. ADVANTAGES Maternal A clear & controlled incision is easy to repair and heals better than a lacerated wound Reduction in the duration of second stage of labor. Reduction of trauma to the pelvic floor muscles that reduces the incidence of prolapse and perhaps urinary incontinance . 27-11-2017 I msc nursing 6

7. ADVANTAGES Fetal It minimizes intracranial injuries specially in premature babies or after coming head of breech. 27-11-2017 I msc nursing 7

8. TYPES OF EPISIOTOMY Median Medio -lateral Lateral J-shaped 27-11-2017 I msc nursing 8

9. Median The incision commences from the centre of the fourchette and extends on the posterior side along the midline for 2.5 cm (1 in). 27-11-2017 I msc nursing 9

10. Medio -lateral The incision is made downward and outward 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 (1 in) away from the anus (midpoint between the anus and the ischial tuberosity). 27-11-2017 I msc nursing 10

11. Lateral The incision starts from about 1 cm (0.4 in) away from the centre of the fourchette and extends laterally. Drawbacks include the chance of injury to the Bartholin's duct, therefore some practitioners have strongly discouraged lateral incisions. 27-11-2017 I msc nursing 11

12. J-shaped The incision begins in the centre of the fourchette and is directed posteriorly along the midline for about 1.5 centimetres (0.59 in) and then directed downwards and outwards along the 5 or 7 o'clock position to avoid the internal and external anal sphincter. This procedure is also not widely practised. 27-11-2017 I msc nursing 12

13. 27-11-2017 I msc nursing 13

14. 27-11-2017 I msc nursing 14

15. 27-11-2017 I msc nursing 15

16. 27-11-2017 I msc nursing 16

17. 27-11-2017 I msc nursing 17

18. 27-11-2017 I msc nursing 18

19. 27-11-2017 I msc nursing 19

20. 27-11-2017 I msc nursing 20

21. 27-11-2017 I msc nursing 21

22. 27-11-2017 I msc nursing 22

23. 27-11-2017 I msc nursing 23

24. 27-11-2017 I msc nursing 24

25. 27-11-2017 I msc nursing 25

26. 27-11-2017 I msc nursing 26

27. 27-11-2017 I msc nursing 27

28. 27-11-2017 I msc nursing 28

29. 27-11-2017 I msc nursing 29

30. 27-11-2017 I msc nursing 30

31. 27-11-2017 I msc nursing 31