Episiotomy

Episiotomy

• 1.
  TOPIC ON EPISIOTOMY
• 2.
  Definition A surgically plannedincision on the perineum and the posterior vaginal wall during the second stage of labour is called episiotomy.
• 3.
  OBJECTIVES • To enlargethe vaginal introitus • To minimize overstretching and rupture of the perineal muscles and fascia. • To reduce the stress and strain on the fetal head.
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  INDICATIONS • Primigravidae ason elective procedure • Face to pubis delivery • Big baby • Narrow pelvic arch • Elderly primigravida • Old perineal scar of episiotomy or perineorrhaphy • Manipulative delivery – forceps, breech etc • To cut short the second stage cases such as pre-eclampsia. • Fetal distress, premature baby
• 5.
  TIMING OF EPISIOTOMY Bulging thinned perineum during contraction.  Just prior to crowning.
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  Advantages • Maternal • Fetal
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  Anatomy of thepelvic floor
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  Step I • Cleaningof the perineum • Draping • Local anaesthesia
• 9.
  Step II Incision Structures cutare • Posterior vaginal wall • Superficial and deep transverse perineal muscles (bulbospongiosus and part of levator ani) • Fascia covering those muscles • Transverse perineal branches of pudendal vessels and nerves • Subcutaneous tissue • Skin
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  Step III Repair • Vaginamucosa and submucosal tissues • Perineal muscles • Skin and subcutaneous tissue
• 11.
  Requirements for episiotomy •Good light source • Linen and dressing • Instruments • Sutures and needles
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  COMPLICATIONS Immediate:  Extension ofthe incision  Vulval haematoma  Infection  Wound dehiscence Remote:  Dyspareunia
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  Post operative care Dressing  Comfort  Ambulate  Removal of stitches
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  CONCLUSION  Definition  Objectives Indications  Timing of episiotomy  Advantages  Types  Steps  Complications  Post operative care