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Episiotomy

Episiotomy is a surgical incision made in the perineum during labor to facilitate delivery and minimize injury to the perineal muscles. It is indicated selectively and should be performed at the right time to be effective, with various types including medio-lateral and median incisions. Complications can arise both immediately and remotely, including infections, pain, and potential injury to surrounding structures.

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Rachana Meruva
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12 views1 page

Episiotomy

Episiotomy is a surgical incision made in the perineum during labor to facilitate delivery and minimize injury to the perineal muscles. It is indicated selectively and should be performed at the right time to be effective, with various types including medio-lateral and median incisions. Complications can arise both immediately and remotely, including infections, pain, and potential injury to surrounding structures.

Uploaded by

Rachana Meruva
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as TXT, PDF, TXT or read online on Scribd
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EPISIOTOMY

Definition : a surgically planned incision on the perineum and the posterior vagina
wall during the second stage of labour is called perineotomy or episiotomy
Objectives
To enlarge the vaginal introitus so as to facilitate easy and safe delivery of the
fetus
To minimise over stretching and rapture of perineal muscles and fascia
To reduce the stress and strain on the fetal head
Indications : episiotomy is recommended in selective cases rather than as a routine
Timings : the timings of performing the episiotomy requires judgement. If done
early, the blood loss will be more if done late, it fails to prevent the invisible
lacerations of the perennial body and thereby fails to protect the pelvic floor.
The very purpose of episiotomy is thus defeated
Bulging Thinned perineum during contraction just prior to crowning is the ideal
time
Types
Medio lateral the incision is made downwards and outward from the midpoint of the
fourchette either to the right or the left it is directed diagonal in a straight
line, which runs about 2.5 cm away from the anus
Median incision commences from the centre of the fourchette an extent posteriorly
along the midline for about 2.5 cm
Lateral the incision starts from about 1 cm away from the centre of the fourchette
and extent laterally
J shaped: the incision begins in the centre of the fourchette and directed
posteriorly along the midline for about 1.5 cm and then directed downwards and
outward along five or 7 o’clock position to avoid anal splinter
Complications
Immediate : extension of the incision to involve the rectum.
Vulval haematoma
Infections : throbbing pain, rising temperature, wounded, the area looks moist,
red swollen
Offensive discharge
Wound Dehiscence
Injury to anal splinter, Reto vaginal fistula rare
Remote
Dyspareunia
Chance of perennial lacerations
Scar endometriosis

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