Episiotomy





Episiotomy
Episiotomy




Is an incision made in the perineum to enlarge the vaginal outlet? it serves the following purposes :

- Prevent tearing of the perineum, substitute a straight surgical incision for the laceration that may otherwise occur.

- Facilitate repair of laceration and promote healing.

- Minimize prolonged and severe stretching of the muscles supporting the bladder or rectum which may later lead to stress incontinence or vaginal prolapse.

- Shorten the second stage, which may be important for maternal reasons as, PIH or fetal reasons for persistent bradycardia.

- Enlarges the vagina in case manipulation is needed to deliver an infant for example in breech presentation or for application of forceps.

Types of Episiotomies:

The type of episiotomy is designated by site and direction of the incision.

1- Median:

- Is one most commonly employed?

- It is effective, easily repaired and generally the least painful.

- The incision is made in the middle of the perineum and directed toward the rectum.

- Is believed to heal with few complications, more comfortable for the women.

- If a long and large incision is needed during delivery, it may necessitate incision into the anal sphincter.

2- Mediolateral:

- The incision is made laterally in the perineum.

- This method avoids the anal sphincter if enlargement is nodded.

- The blood loss is greater, the repair is more difficult.


Assessment:

- The episiotomy site is inspected every 15 minutes during the first hour after delivery, then on a daily basis.

- The site is assessed of tenderness, redness, swelling and evidence hematoma.

Note :
Because suture used to repair episiotomy are of absorbable material they don’t need to be removed and no dressing is applied.



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