This document discusses episiotomy, which is a surgically planned incision made in the perineum and posterior vaginal wall during the second stage of labor. It aims to enlarge the vaginal opening to facilitate delivery and minimize tearing. Common indications include a rigid perineum, operative deliveries, or previous perineal surgery. The main types are mediolateral, median, and lateral incisions. A mediolateral episiotomy has advantages like less blood loss and easier repair compared to other types. The procedure involves preliminaries like anesthesia, followed by the incision and then repair of the vaginal mucosa, muscles, and skin in layers. Post-operative care and potential complications are also
Episiotomy - definition , purpose , indications, anesthesia,timing, Types, Steps of mediolateral episiotomy, precautions, complications and post operative care
Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician. Episiotomy is usually performed during second stage of labor to quickly enlarge the opening for the baby to pass through.
induction of labor Refers to the process of artificial initiation of uterine contractions before their spontaneuos onset, leading to cervical dilatation and effacement and delivery of the baby.
The term usually refers to procedures carried out in the third trimester but occasionally to gestations more than the legal definition of fetal viability (24 weeks)
Episiotomy - definition , purpose , indications, anesthesia,timing, Types, Steps of mediolateral episiotomy, precautions, complications and post operative care
Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician. Episiotomy is usually performed during second stage of labor to quickly enlarge the opening for the baby to pass through.
induction of labor Refers to the process of artificial initiation of uterine contractions before their spontaneuos onset, leading to cervical dilatation and effacement and delivery of the baby.
The term usually refers to procedures carried out in the third trimester but occasionally to gestations more than the legal definition of fetal viability (24 weeks)
This presentation contains :-
1.Introduction of normal labour
2. Definiation of normal labour
3.Criteria of normal labour
4. Physiology of normal labour
5. Pathophysiology of labor
6.Estrogen
7. Prostaglandin
8. Oxytocin
9. True labor and false labor difference
10. Uterine contraction in labor
11. Stages of labour
12. Management of 1 st stage
13. management of 2 nd stage
14. mamagement of 3 rd stage of labor
15. Cervix dilation
16. Friedman's curve
17. Fetal skull
18. Diameter of fetal skull
19. Sutures in fetal head
20. Moulding
21. Mechanism of labour
This topic contains definition, instruments, indications, contraindications, prerequisites, advantages, procedure, complications and hazards of ventouse or vaccum delivery.
Partograph is a composite graphical recording of progress of labour and salient condition of mother and fetus. For progress of labor and conditions of the mother and the fetus. It was developed and extensively tested by the world health organization (WHO)
Presentation on this topic is available on link đ
https://youtu.be/d_JgNiYv7eU
This topic contains detail about genital prolapse in pregnancy, It's definition, incidence, types, stages, causes, risk factors, clinical features, effect of prolapse, effect on pregnancy, effect during labour and puerperium, prevention, treatment and nursing management during pregnancy, labour and puerperium.
This presentation contains :-
1.Introduction of normal labour
2. Definiation of normal labour
3.Criteria of normal labour
4. Physiology of normal labour
5. Pathophysiology of labor
6.Estrogen
7. Prostaglandin
8. Oxytocin
9. True labor and false labor difference
10. Uterine contraction in labor
11. Stages of labour
12. Management of 1 st stage
13. management of 2 nd stage
14. mamagement of 3 rd stage of labor
15. Cervix dilation
16. Friedman's curve
17. Fetal skull
18. Diameter of fetal skull
19. Sutures in fetal head
20. Moulding
21. Mechanism of labour
This topic contains definition, instruments, indications, contraindications, prerequisites, advantages, procedure, complications and hazards of ventouse or vaccum delivery.
Partograph is a composite graphical recording of progress of labour and salient condition of mother and fetus. For progress of labor and conditions of the mother and the fetus. It was developed and extensively tested by the world health organization (WHO)
Presentation on this topic is available on link đ
https://youtu.be/d_JgNiYv7eU
This topic contains detail about genital prolapse in pregnancy, It's definition, incidence, types, stages, causes, risk factors, clinical features, effect of prolapse, effect on pregnancy, effect during labour and puerperium, prevention, treatment and nursing management during pregnancy, labour and puerperium.
TYPES OF MANAGEMENT IN HERNIA (CONSERVATIVE AND OPERATIVE)
TYPES OF SURGERY
(IN CHILDREN/ADULTS ,OPEN/LAPAROSCOPIC)
HERNIOTOMY ,TYPES OF HERNIORRAPHY ,HERNIOPLASTY (INCLUDING MESH)
"LAPAROSCOPIC ANATOMY"
LAPAROSCOPIC REPAIRS (TEP,TAPP)
EMERGENCY AND ELECTIVE TREATMENT IN INGUINAL FEMORAL AND OTHER TYPES OF HERNIAS
COMPLICATIONS
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Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.Â
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ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
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According to WHO,
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In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
 Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratoryÂ
 to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
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2. DEFINITION
âĸ A surgically planned incision
on the perineum and the
posterior vaginal wall during
the second stage of labour is
called episiot
3. OBJECTIVES
âĸ TO enlarge the vaginal introitus so as
to facilitate easy and safe delivery of
the fetus-spontaneous or
manipulative.
âĸ TO minimise overstretching and
rupture of the perineal muscles and
fascia; to reduce the stress and strain
on the fetal head.
4. INDICATIONS
âĸ In elastic perineum;- Causing arrested or delay in decent of the
presenting part as in elderly primigravidae.
âĸ Anticipating perineal tear;-
ī This is widely indicated specially in primigravidae almost as an
elective procedure.
ī Face to pubis or face delivery, big baby, narrow pubis arch.
âĸ Operative delivery;- forceps delivery, ventouse delivery.
âĸ Previous perineal surgery;- pelvic floor repair, perineal
reconstructive surgery.
COMMON INDICATION
ī Threatened perineal injury in primigravidae.
ī Rigid perineum.
ī Forceps, Breech, Occipito-posterior or face delivery.
5. ADVANTAGES
âĸ Maternal-
īA clear and controlled incision is easy to repair
and heals better than a lacerated wound that
might occur.
īReduction in the duration of second stage.
īReduction of trauma to the pelvic floor muscles.
âĸ Fetal-
īIt minimises intracranial injuries specially in
premature babies or after-coming head of breech.
9. MEDIO-LATERAL;
ī The incision is made downwards and out-wards from the
midpoint of the fourchette either to the right or left.
ī It is diagonally in a straight line which runs about 2.5cm away from
anus.
Advantages;-
ī The muscles are not cut.
ī Blood loss is least.
ī Repair is easy.
ī Post operative comfort is superior.
ī Healing is superior.
ī Wound disruption is rare.
Disadvantages;-
ī Extension, if occurs may involve the rectum.
ī Not suitable for manipulative delivery or in abdominal
presentation.
10. MEDIAN
The incision commences from the centre of the
fourchette and extends posteriorly along the
midline for about 2.5cm.
Advantages;-
īRelative from rectal involvement from extension.
Disadvantages;-
īApposition of the tissues is not so good.
īBlood loss is little more.
īPost operative discomfort is more.
īRelative increased incidence of wound disruption.
11. LATERAL
The incision starts from about 1cm away from the
centre of the fourchette and extends laterally.
J-SHAPED INCISION
The incision begins in the centre of the fourchette
and is directed posteriorly along the midline, for
about 1.5cm and then directed downwards along 5
to 7 O clock poInjury to bartholins ducts has more
chance.
sition to avoid the anal sphincter.
Advantages - On extension of incision anal
sphincter will not be affected.
Disadvantages
īRepair and healing is not good.
13. STEP-I (Preliminaries)
The perineum is thoroughly swabbed with
antiseptic lotion and draped properly.
Local anaesthesia- The perineum, in the
line of proposed incision is infiltrated
with 10ml of 1% solution of lignocaine.
14. STEP-II (Incision)
ī Two fingers are placed in the vagina between the
presenting part and the posterior vagional wall.
ī The incision is made by a curved or straight blunt
pointed sharp scissors, one blade of which is placed
inside, in between the fingers and posterior vagional
wall and other on the skin.
ī The incision should be made at the height of an
uterine contraction when an adequate idea of the
extent of incision can be better judged from the
stretched perineum.
ī Deliberated cut should be made starting from the
centre of the fourchette extending laterally either to
the right or to the left.
ī It is directed diagonally in straight line which runs
about 2.5cm away from the anus.
15. STRUCTURES CUT ARE
ī Posterior vaginal wall.
īSuperficial and deep transverse perineal
muscle.
īFascia covering those muscles
īTransverse perineal branches of pudendal
vessels and nerves.
īSubcutaneous tissue and skin.
16. STEP-III (Repair)
Time of repair- The repair is done soon after
expulsion of placenta. If repair is done prior to
that, disruption of the wound is inevitable, if
subsequent manual removal or exploration of
the genital tract is needed. Oozing during this
period should be controlled by pressure with a
sterile gauze swab and bleeding by the artery
forceps. Early repair prevents sepsis and
eliminates the patients prolonged apprehension
of stitches.
17.
18. Preliminaries â The patient is placed in lithotomy
position. A good light source from behind is needed.
The perineum including the wound area is cleansed
with antiseptic solution. Blood clots are removed
from the vagina and the wound area. The patient is
draped properly and repair should be done under
strict aseptic precautions. If the repair field is
obscured by oozing of blood from above, a vaginal
pack may be inserted and is placed high up. Do not
forget to remove the pack after the repair is
completed.
19. âĸ Steps of repair of episiotomy â
ī Wound on inspection.
īRepair of vaginal mucosa and perineal
muscles by interrupted sutures.
īApposition of the skin margins.
īRepaired wound on inspection.
20. The repair is to done in the following order ;--
1. Vaginal mucosa and submucosal tissues.
2. Perioneal muscles.
3. Skin and subcutaneous tissues.
The vaginal mucosa is sutured first. The first suture
is placed at or just above the apex of the tear.
Thereafter, the vaginal wall are apposed by
interrupted sutures with polyglycolic acid suture or
No. O chromic catgut, from above downwards til the
fourchette is reached. The suture should include the
deep tissues to obliterate the dead space. A
continuous suture may cause puckering and
shortening of the posterior vaginal wall.