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.
2. To study about :-
Introduction
Definition
Objectives
Indication
Advantages
Types of episiotomy
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
5.
6. 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.
7. 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
15. 2. Fetal:-
Minimize intracranial injuries specially in
premature babies
Helps to conduct breech delivery
16. There are 4 types of episiotomy-
Mediolateral
Median
Lateral
J shaped
17. The incision commences
from the center of the
fourchette and extends
along posteriorly along
the midline for about
2.5cm
18. 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
19. 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
20. 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
21. 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
22. Ensure good lighting
Check the equipment before starting the
procedure
Provide screening
23.
24. 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
25. 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
26. 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
27.
28. step:-1 Preliminaries:
The perineum is thoroughly
with antiseptic lotion,
Draped properly,
Incision line- Infiltrated with 10 ml
lignocaine solution.
29. 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
30. 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
31. 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 .
32.
33. 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
34. 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
35.
36.
37. 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.
38. Immediate care
◦Inspect the repair to check hemostasis
has been achieved
◦Account for all instruments, swabs and
needle
◦Discard sharp needle safely
39. Apply Sterile pad following through
perineal wash
Wait for minimum one hour to shift
patient to ward
Check for bleeding and urine output
41. 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
42. 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