EPISIOTOMY types,purposes,procedures ppt

Episiotomy is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician. It is usually performed during the second stage of labor to quickly enlarge the opening for the baby to pass through. An episiotomy is an incision made in the perineum during childbirth. Although the procedure was once a routine part of childbirth, that's no longer the case.

1. EPISION=PUBES,PUDENTA
TOMY=CUTTING
PERINEOTOMY
a
EPISIOTOMY

2. DEFINITION :-
a surgically planned incision on the perineum during the
second stage of labor.
PURPOSES:-
• To enlarge the vaginal introitus to facilitate easy and safe delivery
of the fetus .
•To minimize over stretching and rupture of perineal muscles and
fascia.
•To reduce the stress and strain on the fetal head.

3. WHEN
•The baby is very large
•The fetal head is too large even in the vertex position
•Fetus is in breech
•Rigid perineum
•The operative delivery is recommended-forceps and ventous
•Baby’s shoulders r stuck (dystocia)
INDICATIONS

4. Median
Medio-lateral
Lateral
‘J’ shaped
TYPES OF INCISIONS

5. Median:- starts from vaginal opening to anus(straight line)
Medio-lateral:from center of the vagina either to the left or right
towards the buttocks angles 45 degrees
Lateral: incision starts from I cm away from the midpoint
of vagina either left or right side
‘j’shaped:begins in the vagina and is directed posteriorly for
about 1.5cm and then directed downwards and outwards like 5
or 7 ‘o’ clock

7. Including
1 Pair disposable complete leg
sleeves.
4 Sterile drapes.
6 Adhesive tapes 2x10cm to attach
drapes and leg
covers.
1 Stainless-steel needle-holder 7"
(18cm.) long.
1 scissors sharp/blunt.
1 curved hemostat.
4 Gauze balls
10 Gauze sponges 10x10cm
1 Medicine cup 30ml.
1 Syringe 20ml.
1 Needle 18G.
1 Needle 21G.

8. Directions
Direction for use of kit for Episiotomy procedure at childbirth
Preparation:
The following additional items are required:
1. 1 pr. surgical gloves of suitable size
2. antiseptic solution
3. sutures & suitable needles
4. Anesthetics
Direction for use:
1. Open the kit, remove the sterile field, & spread over the patient's abdomen
or over any other working area with the polybacked surface facing
downwards and the absorbent paper surface upwards. It is preferable to
secure the sterile field with the elastic plasters to prevent slipping. Use of
elastic plaster strips: Gently stretch the plaster lengthways, by using both
hands, until the separation is visible at center cut - then easily remove the
silicone paper.

9. 2. Hold the tray on its under surface, & empty its contents onto the sterile field,
taking care to prevent contact of the edge of the tray with the sterile field. Set the
tray aside within easy reach,for use as a container for antiseptic solution during
suturing.
3. Fit the disposable leg-sleeves onto the thighs of the patient, securing them with
plasters.
4. Spread additional sterile field under the buttocks of the patient, with
polybacking facing downwards, - absorbent surface in contact with the patient's
body.
5. Additional sterile drape is for use as an apron or any other covering for the
patient.
6. Remove the sutures aseptically from their first package, and place them on the
sterile field together with the other kit components.

10. 7. Pour antiseptic solution into the kit container. (The
compartment is designed for economy)
8. Put on gloves and mask and commence the suturing
procedure. Use the gauze & cotton tupfers, the "mouse"
tampon, hemostats, syringe plus 2 needles, and medicine
cup, as and when required in accordance with your
experience in these procedures.
9. During and after the suturing procedure, all refuse must
be disposed of in the suitable containers, including all the
instruments - all instruments are for single, one time use
only - for comfort and safety of patients, personnel and
doctors

11. EXPLAIN THE COMPLETE PROCEDURE AND ADVANTEGES
↓
LET THE PATIENT LIE DOWN IN LITHOTOMY POSITION WITH GOOD LIGHT
↓
LOCAL ANAESTHESIA(10ml of 1% lignocaine)
↓
WASH THE PERINEUM
↓
PLACE 2 FINGERS BETWEEN THE VAGINAL WALL AND THE HEAD OF THE FETUS
↓
2-3cm INCISION IS MADE
↓
DELIVER THE CHILD
PROCEDURE-STEPS

12. ↓
WIPE AND WASH AWAY THE BLOOD CLOTS ON THE
PERINEUM
↓
SUTURING WITH POLY GLYCOLIC ACID SUTURE AND ‘O’
CHROMIC CATGUT

13. DRESSING:-
each time following urination & defecation(is done by soaking of antiseptic solution
followed by application of antiseptic powder or ointement(furacin or neosporin)
comfort:-magnesium sulfate compress or infrared heat, analgesic may be used .
ambulation:-allow the patient to move out of bed after 24 hrs.
REMOVAL OF STITCHES:-
if the wound is sutured by catgut or dexon it will be absorbed but silk or nylon non
absorbable material should be removed on 6 th day.
POST OPERATIVE CARE

14. INFECTION
HEMORRHAGE
PAIN
PAIN WITH INTER COURSE.
IRREGULAR BOWEL FUNCTION.
COMPLICATIONS

15. MERITS DEMERITS
THE PERINIAL
MUSCLES ARE NOT
CUT.
REPAIR IS EASY.
HEALING IS FASTER.
WOUND DISRUPTION
IS RARE.
INJURY TO THE
RECTUM.
BLOOD LOSS IS MORE.
DYSPAREUNIA.
INJURY TO THE
BARTHOLIN’S DUCT.