Episiotomy suturing.pptx

By supriya batwalkar
10-01-2024 I msc nursing 1

DEFINITION
 A surgically planned incision on the perineum and the
posterior vaginal wall during the second stage of labor
is called episiotomy or perineotomy.

OBJECTIVE
 To cut short the second stage of labor.
 To enlarge introitus (vaginal opening) in order to
facilitate easy delivery of baby.
 To minimize over stretching and rupture of vagina,
perineal muscles and fascia.
 To reduce stress on fetal head.

INDICATIONS
 In elastic (rigid) perineum.
 Anticipating perineal tear.
 Operative delivery
 Previous perineal surgery.
 Threatened perineal injury in primi gravidae.

TIMING OF EPISIOTOMY
 Bulging thinned perineum during contraction just
prior to crowning (when 3-4 cm of head is visible) is
the ideal time.
 If done early- chances of blood loss.
 If done late – fails to prevent the invisible lacerations
of perineal body.

ADVANTAGES
 Maternal
A clear & controlled incision is easy to repair and heals
better than a lacerated wound
Reduction in the duration of second stage of labor.
Reduction of trauma to the pelvic floor muscles that
reduces the incidence of prolapse and perhaps urinary
incontinance.

ADVANTAGES
 Fetal
It minimizes intracranial injuries specially in
premature babies or after coming head of breech.

TYPES OF EPISIOTOMY
 Median
 Medio-lateral
 Lateral
 J-shaped

Median
 The incision commences from the centre of the
fourchette and extends on the posterior side along the
midline for 2.5 cm (1 in).

Medio-lateral
 The incision is made downward and outward from the
midpoint of the fourchette either to the right or left. It
is directed diagonally in a straight line which runs
about 2.5 cm (1 in) away from the anus (midpoint
between the anus and the ischial tuberosity).

Lateral
 The incision starts from about 1 cm (0.4 in) away from
the centre of the fourchette and extends laterally.
Drawbacks include the chance of injury to the
Bartholin's duct, therefore some practitioners have
strongly discouraged lateral incisions.

J-shaped
 The incision begins in the centre of the fourchette and
is directed posteriorly along the midline for about 1.5
centimetres (0.59 in) and then directed downwards
and outwards along the 5 or 7 o'clock position to avoid
the internal and external anal sphincter. This
procedure is also not widely practised.

Episiotomy suturing.pptx

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Episiotomy suturing.pptx