EPISIOTOMY

WHAT IS AN EPISIOTOMY?

Is a surgical incision made through the

perineum to enlarge the vaginal outlet during

the delivery of the baby.
 CURRENT INDICATIONS – VERY FEW

REDUCED DUE TO RESTRICTIVE USE

POLICY BY……. WHO

TO DELIVER A PREMATURE BABY

INSTRUMENTAL DELIVERY

SHOULDER DYSTOCIA
COMPLICATIONS OF EPISIOTOMY

• Excessive bleeding
• Extended tear
• Infections
• Vaginal narrowing
• Dyspareunia/painful sex
• Urine incontinence
• Fecal incontinence
• Psychological & Physical trauma
 CURRENT EVIDENCE

‘RESTRICTIVE USE’

‘STOP ROUTINE USE’

 TECHNIQUE OF PERFORMING
EPISIOTOMY
qSome form of anaesthesia should be used
before performing the episiotomy.
qThe types of anaesthesia are:
§ Local infiltration
§ Pudental block
§ Caudal block
§ Spinal block
 TECHNIQUE OF PERFORMING
EPISIOTOMY
q The incision is then made using a pair of sharp
scissors during the course of a contraction
when the fetal head is distending the
perineum.
 TECHNIQUE OF REPAIRING
EPISIOTOMY
q The aim of the episiotomy repair is to restore
the normal perineal anatomy without undue
tension and with good haemostasis.
q The repair should be undertaken as soon as
possible after delivery to minimise blood loss
and reactive tissue oedema.
q As with all surgery, the operative felid should
be clearly visualised with a good light directed
at the wound.
 TECHNIQUE OF REPAIRING
EPISIOTOMY
q excess upper genital tract bleeding should be
kept out of operative filed with an adequate
intra-vaginal pack.
 STAGES OF REPAIRING EPISIOTOMY
1. Ensure good exposure of operative site.
2. Identify the apex of incision and place the first suture just proximal
to this point.
3. the posterior vaginal wall is then repaired with a single continuous
unlocked suture.
4. The perineal muscle is usually re-approximated with either a
continuous non-locking stitch or interrupted sutures according to
operator’s preference.
 STAGES OF REPAIRING EPISIOTOMY
5. Closure of the perineal skin should be undertaken using a continuous
subcutaneous subcuticular suture rather than a interrupted suture
to oppose the skin edges. ( evidence suggests that this reduces
post-operative pain)
6. Careful inspection should be undertaken to determine adequate
haemostasis.
7. A rectal examination should be performed to ensure there are no
inappropriate placed sutures.
8. All needles and swabs must be account for.
 KEY POINTS

qIf the episiotomy incision should extend into the

external anal sphincter it is known as a third degree
tear. If the anal mucosa is also breached, the tear is
classified as fourth degree.
qInexperienced obstetricians should not attempt
this type of repair and immediate help be sought.
 KEY POINTS

• If haemostasis is not taken care of, haematoma

formation can occur which, if left unnoticed, can
extend considerably.

• In such circumstances, immediate evacuation of

the haematoma in the operative theater under
good light and anaesthesia should be attempted.