Guided By:- Presented By:-

Dr.Anjalatchi Muthukumaran Ms.Samiksha singh

Vice principal Bsc(n) Iv th year
Era college of nursing Era college of nursing
To study about :-
 Introduction
 Definition
 Objectives
 Indication
 Advantages
 Types of episiotomy
 Enlisting equipments
 Preparation of patient
 Making episiotomy
 Complications
 After care
 Health education
 Episiotomy, also known as perineotomy

 It is a surgical incision of the perineum and the posterior

vaginal wall generally done by a midwife or obstetrician
Which is usually performed during second stage of labor
to quickly enlarge the opening for the baby to pass through
A surgically planned Incision on the perineum
and posterior vaginal wall during the second
stage of labor is called episiotomy
 An episiotomy is a cut (incision) through the area between your
vaginal opening and your anus. This area is called the perineum.
This procedure is done to make your vaginal opening larger for
childbirth.
 Toenlarge the vaginal introits so as to
facilitate easy and safe delivery of the fetus

 Tominimize overstretching and rupture Of the

perineum muscle to reduce the stress and
strain on the fetal head
 Large size baby
 Preterm delivery
 Shoulder dystocia
 Malpresentation
 Unable to respond
to the instructions
1. Maternal:-
 A clear and controlled incision is easy to repair and heals better than
lacerated wound that might occur otherwise.
 Reduction in the duration of second stage
2. Fetal:-

 Minimize
intracranial injuries specially in
premature babies

 Helps to conduct breech delivery

There are 4 types of episiotomy-

 Mediolateral
 Median
 Lateral
 J shaped
 Theincision commences
from the center of the
fourchette and extends
along posteriorly along
the midline for about
2.5cm
 The incision is made
downwards and outwards from
the midpoint of the fourchette
either to the right or to the left

 It is diagonally in a straight line

which runs about 2.5 Cm away
from thre anus
 The incision starts from about
1cm away from the center of
the fourchette and extends
laterally

 It has drawbacks like chances of

injury to the Bartholins duct
 The incision begins in the
center of the fourchette and
directed along the midline for
about 1.5cm and then directed
downwards and outwards along
5 or 7 O’clock position to avoid
anal sphincter
 This is not done widely
 Check doctor’s order
 Establish rapport with patient
 Ensure that women consents to the procedure
 Provide comfort to patient
 Explain in short about the procedure
 Ensure good lighting
 Check the equipment before starting the
procedure
 Provide screening
Kidney tray To collect the waste
material
Pair of gloves To prevent the
infection
Gauze swabs To wipe the blood

Needle holder To hold the needle

while suturing
Sponge holder To hold the Gauze
pieces
ALLIS FORCEP To hold heavy tissue

Artery forcep To control bleeding

Lignocaine % Local anesthetic

Catgut suture To repair the

episiotomy
Episiotomy Scissors For incision
10 ml syringe For administration of
anesthesia

Adson forcep To provide hemostasis

Sponge holder To hold the cervix to see

if there is any cervical
tear
step:-1 Preliminaries:
 The perineum is thoroughly
with antiseptic lotion,
 Draped properly,
 Incision line- Infiltrated with 10 ml
lignocaine solution.
Step :-2 Incision
 Two fingers are placed in vagina between the
presenting part and the vaginal wall

 The incision is made by curved or straight blunt

pointed sharp scissor or scalpel

 One blade of which is placed inside , in between

the fingers and the posterior vaginal wall and the
other on the skin
 The incision should be made at a height of uterine
contraction

 Deliberate cut should be made starting from the center of

the fourchette extending laterally either to the right or to
Left.

 It is directed diagonally in a straight line which runs

about 2.5cm away from the anus
 Posterior vaginal wall
 Superficial and deep transverse perineum
muscle
 Fascia covering those muscles
 Transverse perineum branches of pudendal
vessels and nerves
 Subcutaneous tissue and skin .
 Step:-3 REPAIR
Timing of repair:- soon after expulsion of placenta
Preliminaries:-
 The patient is placed in lithotomy position
 A good light source
 Clean the perineum area and wound with
antiseptic solution
 Remove the blood clots from vagina and wound
area
 Therepair should be done under strict
aseptic precautions

The repair is done in three layers

:-
 Vaginal mucosa and submucosal tissue
 Perineal muscles
 Skin and subcutaneous tissue
 Bleeding.
 Tearing into the rectal tissues and anal sphincter muscle which
controls the passing of stool.
 Swelling.
 Infection.
 Collection of blood in the perineal tissues.
 Pain during sex.
Immediate care
◦ Inspect the repair to check hemostasis
has been achieved
◦ Account for all instruments, swabs and
needle
◦ Discard sharp needle safely
 Apply Sterile pad following through
perineal wash
 Wait for minimum one hour to shift
patient to ward
 Check for bleeding and urine output
Post operative care
1. Dressing
2. Comfort
3. Ambulance
4. Removal of stitches
 Eat a diet high in Fiber and fluid to prevent
constipation
 Ask the women to walk with thigh apposed
 Not to use squatting position since wound is
healing
 Change sanitary pad at least every 4 hours to
help prevent infection
 Sitin a tub of warm water
 Always wash hands before and after
going to bathroom
 Always keep the wound clean and dry
after each urination and defecation