Episiotomy
A surgically planned incision on the perineum and the posterior vaginal
wall during the second stage of labor is called episiotomy (perineotomy )
It is the most common obstetric operation performed
Objectives:
• to erlange the vaginal introitus so as to facilitate easy and safe delivery
• to minimise overstretching and rupture of perineal muscles and fascia
and ↓ stress & strain on fetal head
Indications:
. In elastic ( rigid ) perineum (mostly in primigravidae)
. Anticipating perineal tear: (a) big baby (b) face to pubis d elivery (C) breech
delivery (d) shoulder dystocia
• Operative delivery ( forceps delivery )
• previous perineal surgery
Timing of the episiotomy: bulging thinned perineum during contraction just
prior to crowning (when 3- 4 cm of head is visible ) is the ideal time.
, Advantages:
Maternal: (a) clear and controlled incision is easy to repair and heals better
than a lacerated wound. (B) ↓ the duration of second stage. (C) ↓ trauma
to pelvic floor muscles thus reducing incidences of prolapse.
Fetal: minimizes intracranial injuries especially in premature babies
Or after-coming head of breech
Types: * mediolateral * median
* lateral * ‘J’ shaped
1. Mediolateral: incision is made downwards and outward from the
midpoint of the fourchette either to the left or right.
Directed diagonally in a straight line 2.5cm away from the anus.
2. Median: incision from the center of fourchette and extends posteriorly
along the midline for about 2:5cm.
3.Lateral: incision starts from 1 cm away from the center of fourchette &
extends laterally.
There are chances of injury to the bartholin’s duct hence totally
condemned.
4.’J’ shaped: incision begins in the center of the fourchette and is
directed posteriorly along the midline for about 1.5cm and then directed
downwards and outwouds along 5 or 7 o'clock position to avoid anal
sphincter.
Apposition is not perfect & wound tends to fold.
A surgically planned incision on the perineum and the posterior vaginal
wall during the second stage of labor is called episiotomy (perineotomy )
It is the most common obstetric operation performed
Objectives:
• to erlange the vaginal introitus so as to facilitate easy and safe delivery
• to minimise overstretching and rupture of perineal muscles and fascia
and ↓ stress & strain on fetal head
Indications:
. In elastic ( rigid ) perineum (mostly in primigravidae)
. Anticipating perineal tear: (a) big baby (b) face to pubis d elivery (C) breech
delivery (d) shoulder dystocia
• Operative delivery ( forceps delivery )
• previous perineal surgery
Timing of the episiotomy: bulging thinned perineum during contraction just
prior to crowning (when 3- 4 cm of head is visible ) is the ideal time.
, Advantages:
Maternal: (a) clear and controlled incision is easy to repair and heals better
than a lacerated wound. (B) ↓ the duration of second stage. (C) ↓ trauma
to pelvic floor muscles thus reducing incidences of prolapse.
Fetal: minimizes intracranial injuries especially in premature babies
Or after-coming head of breech
Types: * mediolateral * median
* lateral * ‘J’ shaped
1. Mediolateral: incision is made downwards and outward from the
midpoint of the fourchette either to the left or right.
Directed diagonally in a straight line 2.5cm away from the anus.
2. Median: incision from the center of fourchette and extends posteriorly
along the midline for about 2:5cm.
3.Lateral: incision starts from 1 cm away from the center of fourchette &
extends laterally.
There are chances of injury to the bartholin’s duct hence totally
condemned.
4.’J’ shaped: incision begins in the center of the fourchette and is
directed posteriorly along the midline for about 1.5cm and then directed
downwards and outwouds along 5 or 7 o'clock position to avoid anal
sphincter.
Apposition is not perfect & wound tends to fold.
