TOPIC ON EPISIOTOMY

Definition A surgically planned incision on the perineum and the posterior vaginal wall during the second stage of labour is called episiotomy.

OBJECTIVES To enlarge the vaginal introitus To minimize overstretching and rupture of the perineal muscles and fascia. To reduce the stress and strain on the fetal head.

INDICATIONS Primigravidae as on 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

TIMING OF EPISIOTOMY Bulging thinned perineum during contraction. Just prior to crowning.

Advantages Maternal Fetal

Anatomy of the pelvic floor

Step I Cleaning of the perineum Draping Local anaesthesia

Step II Incision Structures cut are 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

Step III Repair Vagina mucosa and submucosal tissues Perineal muscles Skin and subcutaneous tissue

Requirements for episiotomy Good light source Linen and dressing Instruments Sutures and needles

COMPLICATIONS Immediate: Extension of the incision Vulval haematoma Infection Wound dehiscence Remote: Dyspareunia

Post operative care Dressing Comfort Ambulate Removal of stitches

CONCLUSION Definition Objectives Indications Timing of episiotomy Advantages Types Steps Complications Post operative care

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