This document discusses episiotomy, including its definition as a surgically planned incision made during childbirth, purposes such as facilitating delivery and reducing perineal tearing, types (median, mediolateral, lateral), indications, advantages, repair process, post-operative care, and potential complications. The repair process involves suturing the vaginal mucosa, perineal muscles, and skin in layers to restore anatomical structure while controlling bleeding and preventing infection.

1. Episiotomy and its
repair…
Lt Kalaivani R

2. Episiotomy
 Definition
 Purpose
 Indications
 Advantages
 Types
 Perineal repair
 Perineal Care
 Complication

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

4. Purpose
 To enlarge the vaginal introitus
 To facilitate easy & safe delivery
 To minimize rupture of the perineal
muscles & facia.
 To reduce stress on fetal head.

5. Indications
 In rigid perineum

6.  Anticipating perineal tear:
 Big baby
 Face to pubis delivery
 Breech delivery
 Shoulder dystocia

7. Common indication
Threatened perineal injury
Rigid perineum
Forceps delivery

8. Advantages
Maternal Fetal
 Easy to repair  Minimizes
 Reduction in intracranial
duration of labour
injuries esp. in
 Reduction of
premature
trauma
babies

9. Timing of episiotomy
Bulging thinned perineum
during contraction just prior
to crowning

10. Types of episiotomy
 Medio lateral
 Median
 Lateral
J shaped

11. Medio lateral :
 Begins at the midpoint of the
fourchette
 Directed at a 45 degree angle to
the midline
 Towards a point midway between
the ischial tuberosity & the anus.

13. MERITS DEMERITS
MEDIAN
 Safety from  Apposition of
rectal tissue not so
involvement good
 Incision can  Discomfort is
be extend. more.
 Wound
disruption is
more

14. Median :
 Midline incision that follows
the natural line of insertion
of the perineal muscles.

15. Merits Demerits
 Reduced blood  Extension may
loss involve the
 Easy to repair rectum
 Lesser pain  Damage to anal
sphincter

16. Medio lateral episiotomy
 Step 1:preliminaries
 Step 2:Incision
 Step 3:Repair

17. Equipments :
 Sterile drape
 Sterile gown and gloves
 Gauze swabs and tampon
 Needle holder
 Sponge holder
 Scissors ,10 ml syringe
 Toothed forceps
 Suture material
 1% lignocaine

18. 1 :Preliminaries:
 The perineum is thoroughly
swabbed with antiseptic lotion,
 Draped properly,
 Incision line- Infiltrated with 10 ml
of 1% lignocaine solution.

19. 2:Making Episiotomy
• Two fingers are placed in the
vagina between the presenting
part & posterior vaginal wall.

20.  The incision is made by straight
or curved blunt pointed sharp
scissors
 The open blades are positioned.

21.  Incision should be made at the
height of an contraction.
 Cut should be made starting from
the centre of the forchette
extendening laterally either to the
left or right.

22.  It is directed diagonally in a
straight line which runs about 2.5
cm away from the anus.

23.  If delivery of the head does not
follow immediately, apply pressure
to the episiotomy site.
 Control delivery of the head to
avoid extension of the episiotomy.

24. Structures involved :
 Posterior vaginal wall
 Superficial & deep transverse
perineal muscles

25.  Fascia covering the muscles
 Transverse perineal branches of
pudendal vessels& nerves
 Subcutaneous tissue & skin.

26. 3:Perineal Repair
 Repair is done soon after the
expulsion of the placenta.

27. Purpose of Repair
To control bleeding
 To prevent infection
 To assist wound healing by
primary intention.

28. The most common suture type
 polyglactin 910 suture:
Coated Vicryl, Vicryl RAPIDE (> 70%)
 polyglycolic acid:
Safil, Safil Quick, Dexon II (12%)
 Traditional sutures :
catgut, chromic catgut) (10%).

29. Preliminaries :
 The patient is placed in
lithotomy position
A good light source from behind
is needed to find the apex first.

30.  The perineum &the wound area
is cleaned with antiseptics
 Blood clots are removed from the
vagina & the wound area

31.  The patient is drapped properly
&repair should be done under
strict aseptic precaution
A vaginal pack is inserted & is
placed high up.

32. Principles in suturing
 Close all dead space –ensure
haemostasis and prevent
infection

33. Cotton balls must not be used.
 Handle tissue gently using non
toothed forceps.
Ensure good anatomical restoration
and alignment to facilitate healing.

34. • Use minimal amount of suture
material, and do not over tighten suture
this may impede healing.
• Following the repair a rectal examination
should be performed to ensure no suture
material has been inserted through the
rectal mucosa.

35. Layers of perineal repair
 Vaginal mucosa & submucosal
tissue.
 Perineal muscles
 Skin & subcutaneous tissue

37. Step 1 Suturing the vagina
• Identify the apex.
• Insert the anchoring suture 0.5 cm
above the apex.
• Repair the vaginal wall with a
continuous non-locking stitch with
approximately 0.5 cm between each
stitch.

38. Step 2 Suturing the perineal
muscle
 Check the depth of the trauma.
 Repair the perineal muscles in one or
two layers with the same continuous
stitch.
 Ensure the muscle edges are apposed
carefully leaving no dead space.

39.  On completion of the muscle
layer, the skin edges should align
 so that they can be brought together
without tension.

40. Step 3 Suturing the skin
• Reposition the needle at the inferior
end of the wound commence.
• Stitches are placed below the surface
of the skin,

41. • The point of the needle should be
repositioned between each side,
• So that it faces the skin edge being
sutured.
• Continue taking bites of tissue from each
side until the superior wound edge is
reached.

42. Immediate care
• Inspect the repair to check that
haemostasis has been achieved
• Remove the vaginal tampon, if used,
• Account for all instruments, swabs and
needles
• Discard sharps safely

43. Apply sterile pad following thorough
perineal wash
Wait for minimum one hour to shift the
patient to ward
Check for bleeding & urine output

44. Immediate Remote
 Vulval hematoma  Dyspareunia
 Infection  Scar endometriosis
 Recto vaginal fistula
 Wound dehiscence
complications

45. Health education
• Eat a diet high in fibre and fluids to
prevent constipation
• Ask the women to walk with thighs
apposed,
• not to use squatting position since the
wound is healing.

46. Perineal hygiene
 Change sanitary pads at least every 4
hours to help prevent infection.
 squirt warm tap water over the
perineum, beginning at the front and
moving toward the back .

47. • Sit in a tub of warm water
• Always wash hands thoroughly before
and after going to the bathroom.
• Always keep the wound clean & dry after
each urination & defecation.

48. kegal’s exercise
• Squeeze the perineal muscles as if
you were trying to stop the flow of
urine.
• Hold for 5 to 10 seconds and then
relax. Do this exercise 10 times a day
to regain muscle strength.