The document provides an overview of episiotomy, a surgical incision made during the second stage of labor, indicating its definition, timing, indications, and types. It outlines preparation, steps for the procedure, repair layers, care, and potential risks associated with the procedure. Key care strategies include local wound care, pain management, and Kegel exercises, with risks such as bleeding, infection, and prolonged recovery time noted.

1. Presentation of midwifery and obstretics nursing

2. Defination-
 It is also known as perineotomy .
 It is a surgically planned incision on the perineum and the
posterior vaginal wall during second stage of labour.

3. Time of episiotomy-

4. Indication of episotomy-
 Prolonged second stage of labor.
 Fetal distress.
 Forcep and vacum delivery.
 Baby in breech pesentation.
 Twins or multiples deliveries.
 Large size of baby.
 Abnormal position of the baby head
 The mother has a history of pelvic surgery.
 Hydrocephalus
 Cord prolapse
 Face presentation

6. Types of episiotomy-
1. Medio-lateral
2. Medline
3. Lateral episiotomy
4. J-shaped

8. Degree of episiotomy-
 First stage
 Second stage
 Third stage
 Fourth stage

9. Preparation of articles

10. Steps of episiotomy-
Step 1-
 10 ml lignocane [1% ]local anesthesia
 Clean the perineum area [antiseptic solution].
Step2-
 Incision.
 To prevent injury of presenting part.
Step 3-
 Placenta delivery then reparing .

11. Layers-
The repair is to be done in the following orders;
 Vaginal mucosa
 Perineal muscles
 Skin

12. Scale of episiotomy
 REEDA scale-
 R-Redness
 E –edema
 E –ecchymosis
 D –discharge
 A - allignment

13. Care of episiotomy-
 Local wound care
 Pain mangment
 During the first 12 hour after delivery, an ice pack may
be helpful in preventing both pain and swelling of the
site of the episiotomy
 The episiotomy site should be cleaned after a bowel
movement or after urination
 Kegel exercise- help make the muscles strong
 Removal of stitches- non absorable [6th day]

14. Risk of episiotomy-
 Bleeding
 Infection
 Painful sex
 Injury to the anal sphincher and rectum
 Scarring
 Urinary incontinence
 Prolonged recovery time