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DR Manal Behery
Professor Ob&Gyne
Zagazig University 2014
DefinitionDefinition
Intrapartum incision of perineum also called
perinotomy
Types
Median (midline):midline incision of...
Types of episotomyTypes of episotomy
IndicationsIndications
– Use for maternal or fetal indications
1-Reduce second stage of labor
2-Avoiding severe maternal...
Does every case needs episotomy?Does every case needs episotomy?
ACOG Do not support routine or “liberal”
use
– Gradual d...
Rapidly do episiotomy inRapidly do episiotomy in
– 1-Non reassuring CTG
– 2-Shoulder dystocia
– 3-Operative vaginal delive...
Episotomy for shoulderEpisotomy for shoulder
dystociadystocia
Before forceps applicationBefore forceps application
Delivery of aftercoming headDelivery of aftercoming head
in breechin breech
At what time in labor youAt what time in labor you
should do an episotomy ?should do an episotomy ?
Just at Crowning:Just at Crowning:
Before Crowning AfterBefore Crowning After
12
What type of anesthesia???What type of anesthesia???
Local infiltration anathesiaLocal infiltration anathesia
Pudendal nerve blockPudendal nerve block
.
.
Give plenty of anesthesiaGive plenty of anesthesia
Even patients with epidurals can benefit fromEven patients with epidura...
Muscle cutted in episiotomyMuscle cutted in episiotomy
Vaginal RepairsVaginal Repairs
Goal is to return all structures to normal
anatomy
Use the hymen remnant as key landmark
...
Episiotomy RepairEpisiotomy Repair
Episiotomy RepairEpisiotomy Repair
Problems arising from EpisiotomyProblems arising from Episiotomy
24
Pain
Edema
Bleeding
Infection
Defects in wound
Extension TearsExtension Tears
Generally
•1st
and 2nd
degree tears are
simple to repair
•If you haven’t done many
3rd
and ...
Anal sphincter or rectal injuryAnal sphincter or rectal injury
Extension tear during episotomyExtension tear during episotomy
Extension tear during episotomyExtension tear during episotomy
Complete perineal tear
Pain after EpisiotomyPain after Episiotomy
Topical lidocaine not effective
.1- Ice packs
2. Pressure dressings
3. Appropr...
Pain out of proportion can be sign of vulvar,Pain out of proportion can be sign of vulvar,
paravaginal, ischiorectal hemat...
Need for surgical interventionsNeed for surgical interventionsNeed for surgical interventionsNeed for surgical interventio...
Episotomy for undergraduate
Episotomy for undergraduate
Episotomy for undergraduate
Episotomy for undergraduate
Episotomy for undergraduate
Episotomy for undergraduate
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Episotomy for undergraduate

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undergraduate course lectures in obstetrics and gynecology prepared by Dr Manal Behery Professor OB&GYNE Faculty of medicine,Zagazig University

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Episotomy for undergraduate

  1. 1. DR Manal Behery Professor Ob&Gyne Zagazig University 2014
  2. 2. DefinitionDefinition Intrapartum incision of perineum also called perinotomy Types Median (midline):midline incision of perineum Mediolateral :begins in midline but directed laterally .
  3. 3. Types of episotomyTypes of episotomy
  4. 4. IndicationsIndications – Use for maternal or fetal indications 1-Reduce second stage of labor 2-Avoiding severe maternal lacerations 3-Allow slow controlled dilation and delivery 4-With instrumental delivery to reduce trauma to pelvic floor
  5. 5. Does every case needs episotomy?Does every case needs episotomy? ACOG Do not support routine or “liberal” use – Gradual decrease in use in 1980
  6. 6. Rapidly do episiotomy inRapidly do episiotomy in – 1-Non reassuring CTG – 2-Shoulder dystocia – 3-Operative vaginal delivery – 4- Breech Delivery
  7. 7. Episotomy for shoulderEpisotomy for shoulder dystociadystocia
  8. 8. Before forceps applicationBefore forceps application
  9. 9. Delivery of aftercoming headDelivery of aftercoming head in breechin breech
  10. 10. At what time in labor youAt what time in labor you should do an episotomy ?should do an episotomy ?
  11. 11. Just at Crowning:Just at Crowning:
  12. 12. Before Crowning AfterBefore Crowning After 12
  13. 13. What type of anesthesia???What type of anesthesia???
  14. 14. Local infiltration anathesiaLocal infiltration anathesia
  15. 15. Pudendal nerve blockPudendal nerve block . .
  16. 16. Give plenty of anesthesiaGive plenty of anesthesia Even patients with epidurals can benefit fromEven patients with epidurals can benefit from local injection due to varying levels oflocal injection due to varying levels of anesthesiaanesthesia
  17. 17. Muscle cutted in episiotomyMuscle cutted in episiotomy
  18. 18. Vaginal RepairsVaginal Repairs Goal is to return all structures to normal anatomy Use the hymen remnant as key landmark Suture used – 2-0 Vicryl or monocryl common – 2-0 chromic maybe used but some patients can have reactions
  19. 19. Episiotomy RepairEpisiotomy Repair
  20. 20. Episiotomy RepairEpisiotomy Repair
  21. 21. Problems arising from EpisiotomyProblems arising from Episiotomy 24 Pain Edema Bleeding Infection Defects in wound
  22. 22. Extension TearsExtension Tears Generally •1st and 2nd degree tears are simple to repair •If you haven’t done many 3rd and 4th degree tears call for help Gyn or Colorectal
  23. 23. Anal sphincter or rectal injuryAnal sphincter or rectal injury
  24. 24. Extension tear during episotomyExtension tear during episotomy
  25. 25. Extension tear during episotomyExtension tear during episotomy
  26. 26. Complete perineal tear
  27. 27. Pain after EpisiotomyPain after Episiotomy Topical lidocaine not effective .1- Ice packs 2. Pressure dressings 3. Appropriate analgesia
  28. 28. Pain out of proportion can be sign of vulvar,Pain out of proportion can be sign of vulvar, paravaginal, ischiorectal hematoma orparavaginal, ischiorectal hematoma or cellulitiscellulitis – Examine patient if stable non expandinghematoma can monitor
  29. 29. Need for surgical interventionsNeed for surgical interventionsNeed for surgical interventionsNeed for surgical interventions 1. Haematomas >5cm in diameter1. Haematomas >5cm in diameter 2. Rapidly expanding2. Rapidly expanding Infra-levetor hematoma

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