EPISIOTOMY

MS. MARY DEEPA

M.Sc NURSING-II YR
DEPT.OF OBG
INTRODUCTION
 Episiotomy is in fact an inflicted second degree
perineal injury. It is the most common obstetric operation
performed. Perineal care with episiotomy in the postnatal
period is important in reducing puerperal complications
like puerperal sepsis and puerperal pyrexia.
DEFINITION

 A surgically planned incision on the perineum and the

posterior vaginal wall during the second stage of labour is
called episiotomy or perineotomy.
OBJECTIVES

To enlarge the vaginal introitus so as to facilitate easy and

safe delivery of the fetus- spontaneous or manipulative

To minimize overstretching and rupture of the 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. Constant care during the second stage reduces
the incidence and perineal trauma.
In elastic (rigid) perineum: causing arrest or delay in

decent of the presenting part as in elderly primigravidae.

INDICATIONS
Anticipating perineal tear:
 a) big baby
 b) face to pubis delivery
 c) breech delivery
 d) shoulder dystocia

Operative delivery: forceps delivery, ventouse delivery

Previous perineal surgery: pelvic floor repair, perineal
reconstructive surgery
Threatened injury in primigravidae
Breech , occipito-posterior or face delivery
TIMING OF THE EPISIOTOMY
If done early, the blood loss will be more. If done late, it
fails to prevent the visible lacerations of the perineal body
and thereby fails to protect the pelvic floor.

The very purpose of the episiotomy is thus defected,

bulging thinned perineum during contraction just prior to
crowing (when 3-4 cm of head is visible) is the ideal time.
During forceps delivery, it is made after the application of
babies.
POST OPERATIVE CARE
DRESSING: The wound is to be dressed each time
following urination & defecation to keep the area clean and
dry. The dressing is done in antiseptic solution/antiseptic
powder/ointment (Furacin or neosporin)

COMFORT: Mgso4 compress or application of infra red

heat may be used. Ice packs reduces swelling and pain also.
Analgesic drugs (Ibuprofen) may be given.
Conti…
AMBULANCE: The patient is allowed to move out of the
bed after 24hours. Prior to that, she is allowed to roll over
side or even sit but only with thighs apposed.

REMOVAL OF STITCHES: the stiches to be cut of on 6th

day. The number of stitches to be checked