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EPISIOTOMY Definition Episiotomy is a surgically planned incision on the perineum and posterior vaginal wall performed during the second stage of labor to facilitate delivery. Purposes 1. To substitute a straight surgical incision for the laceration that may otherwise occur. 2. To facilitate repair of incised area and promote healing. 3. To spare the newborns head from prolonged pressure and to avoid pushing against rigid perineum. 4. To shorten the second stage of labor. 5. To speed delivery if there is any fetal distress. 6. Prior to an assisted delvery such as forceps or ventose extraction. 7. To minimise the risk of intracranial damage. 8. To prevent overstreching of the perineal muscles. Types Median or midline- incision made in the middle of the perineum and directed towards the anus. Mediolateral- incision begins at the midline and is directed laterally. Indications 1. 2. 3. 4. 5. Inelastic rigid perineum Primigravida Anticipated perineall tear Operative delivery Previous perineal surgery

Articles A sterile tray containing a. b. c. d. e. f. g. h. i. j. k. Sterile syringe with needle Needle holder-1 Episiotomy scissors-1 Suture cutting scissors-1 Cutting needle-1 for skin, round body needle for muscles Thump forceps Suture material-2-0chromic catgut-1 Kidney tray Plain lignicaine 2% Antiseptic solution Sterile gloves

l. 4x4 gauze pieces m. Tampons General instructions 1. Ensure that a. The presenting part is directly applied to the perineal tissues, which will be evidenced as buldging perineum. b. Vaginal orifice is distended approximately 3cm diameter of the presenting part between contractions. 2. The presenting part of the fetus should be protected from injuries 3. The timing of the cut should be such that the lacerations are prevented and unnecessary blood loss can be prevented and unnecessary blood loss avoided. Procedure Sl. No 1. Nursing action Place the patient on the delivery table in dorsal recumbent position when the fetal head is distending the perineum Infilterate the perineum using 10ml of local anesthetic.Wait for 3-5 min for the action. Place your index finger and middle fingers in the vagina with palmar side down and facing you. Rationale Gives clear visualization



Provides protection to the presenting part in two ways: a. The fingers are against the presenting part and are thick enough so that the scissors , if properly placed will not hurt the baby. b. The outward pressure directs the perineal body away from the baby.


Place the blades of the scissors in straight up and down position , so that one blade is against the posterior wall and and the other blade against the skin of perineal body with the point where the blades cross at the middle of the posterior fourchette. Adjiust the length of the blades of the The length of the incision should be scissors on the perineal body and predict adequate to deliver the fetal head. the length of the incision accordingly. a. A mediolateral episiotomy cut at



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a slant, starting at the midline of the fourchette with the points of the scissors directed towards the ischeal tuberosity on the same side as the incision. b. A midline episiotomy cut in the middle of the central tendinous points of the perineum from the posterior fourchette down to the externall anal sphincter. If a midline episiotomy was cut, palapate the external anal sphincter. Cut again if needed, avoid snipping. Extend the vaginall side of the incision if needed by incising the vaginal band. For this, the scissors must come from above the backside of the hand to slide down the fingers and make the cut. Apply pressure in 4x4 sponges After completion of delivery assist for the suturing of the episiotomy incision. Wipe the wound area with sterile antiseptic cotton swabs. Focus light on the perineal area. Diagnose th edegree of perineal teat if any. Pack the vagina with tampoon Visualize the apex of the mucosa, start suturing using round body needle. Repair the perineal muscles by interrupted sutures Remove the vaginal pack which was inserted during suturing Clean the perineum and apply pads Ask the patient to lie down in supine position Wash and dry the equipments used Record the time of episiotomy performed

Protects the fetal presenting part

Control any slight bleeding present

Prevent spread of microorganisms Give clear perineum. visualization of the

To prevent bleeding

Make patient comfortable

Act as a communication between staff members

1. Check for any bleeding from inner areas or hematoma formation. 2. Check the vital signs.

3. Check for any tear or laceration. Complication 1. 2. 3. 4. 5. 6. Hematoma Infection Perineal laceration Wound dehiscence Dysparenuia Scar endometrosis