EPISIOTOMY

 Episiotomy:-

A surgically planned incision on the perineum & vaginal wall during the second stage of labour

Also known perinotomy

Just prior to crowning is the ideal time for episiotomy

It is done routine case 

Objective:-

To enlarge vaginal introit us

To minimize overstretching

Easy & safe delivery of fetus

Indications:-

Rigid perineum causing arrest or delay in descent of presenting part (Primigreavida)

Big baby

Breech delivery

Shoulder dystocia

Forceps delivery

Ventouse delivery

Previous surgery (Perineal)

Timing:- Bulging thinned perineum during contraction just prior to crowning

Advantage:- Clear & controlled incision heals easily

Reduction in duration of II nd stage

Increase  chance of trauma

Fetal:- Minimize intracranial Injuries

Type:-

(1) Medio-Lateral:-

Incision is made down ward & out wards from mid point of fourchette

Directed diagonally in straight line which run abt. 2.5 cm away from anus

(2) Medium:-

Incision begins in the centre of fourchette

Approximately 2.5 cm in mid line of the perineum

(3) Lateral:-

Invasion is began one or more cm distant from centre of the fourchette

(4) “J” shaped:-

Incision is made in the centre of the fourchette and directed posterior in the midline about 2 cm and dissected towards 7 0 clock position

10 ml. of 1 % lignocane local Anesthesia is used

Complication:-

(1) Immediate:-

Extension of incision

Vulval hematomas

Injury to anal sphincters

Infection

RVF

Remote:-

Dyspareinis

Chance of perineal lacerations

Scar

Pre-operative case:-

Swab perineum with antiseptic lotion

Local anesthesia

Empty bladder & bowel

Line of incision in infill acted with 10 ml of 1% solution of lignocaine

Post operative case:-

Dressing:- After urination & defection each time

Comfort:- Mgsou compress

Aspirin

Ambulance:- Allow Pt to move

Ask her to roll over to her side

Or to sit with thing opposed

Removal of stitches:- After 6th day