1. TOPIC ON EPISIOTOMY

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

3. 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.

4. 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

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

6. Advantages
Maternal
Fetal

7. Anatomy of the pelvic floor

8. Step I
Cleaning of the perineum
Draping
Local anaesthesia

9. 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

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

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

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

13. Post operative care
Dressing
Comfort
Ambulate
Removal of stitches

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

15. THANK YOU