EPISIOTOMY
By
Dr. SHIKHA SHARMA
EPISIOTOMY
An episiotomy is a surgical cut in the muscular area between the vagina and the anus (the area called the perineum) made just before delivery at the time of crowning to enlarge the vaginal opening.
These serious tears result in more perineal pain after the birth, require a significantly longer recovery period, and are more likely to interfere with the strength of the pelvic floor muscles. Tears that disrupt the anal sphincter make it more likely that the mom will have anal incontinence – trouble controlling bowel movements or gas.
INDICATIONS
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TYPES
There are four main types of episiotomy:
Medio-lateral: The incision is made downward and outward from midpoint of fourchette either to right or left. It is directed diagonally in straight line which runs about 2.5 cm away from the anus (midpoint between anus and ischial tuberosity).
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Median: The incision commences from centre of the fourchette and extends on posterios side along midline for 2.5 cm.
Lateral: The incision starts from about 1 cm away from the centre of fourchette and extends laterally. Drawback include chance of injury to Bartholin's duct. Thus some practiotioners have totally condemned it.
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'J' shaped: The incision begins in the centre of the fourchette and is directed posteriorly along midline for about 1.5 cm and then directed downwards and outwards along 5 or 7 o'clock position to avoid the anal sphincter.
The procedure for suturing an episiotomy can be performed using standard instruments.
Materials needed:
1. Needle holder
2. Suture ( 0 chromic catgut)
3. Scissors
4. Forcep
General Instructions for Use*
1. It is recommended that the deep sutures be placed first.
Therefore, evenly place three interrupted sutures into the perineal incision.
2. Complete the repair by beginning 1 cm above the vaginal apex with a stasis structure. After tying this suture, cut the short end only and continue on with locked mattress sutures to the introitus.
3. Next, insert the needle down into the perineal subcutaneous tissue, just in front of the needle exit hole from the last vaginal
structure. In this way, the vaginal suturing will not open up.
4. Continue with evenly placed unlocked continuous surgical gut structures. When the last suture is placed, insert the needle subcutaneously, and exit subcuticularly (1 cm below the epithelium) at the posterior apex of the perineal incision.
5. Begin subcuticular structures, alternating sides until the introitus is reached again.
The suture can be tied off at this point with one last lateral suture to make a tail of the suture with which to tie.
6. Taking the last subcuticular suture back under the hymenal ring into the vagina, one last lateral suture between previously placed mattress sutures can also be done to end the repair. (In this way, the knot will not rub on the perineal pad and cause discomfort to a real woman’s episiotomy.)
Notify your physician/midwife if you have any of the following:
Bleeding from the episiotomy site.
Foul-smelling drainage from the vagina.
Fever and/or chills.
Severe perineal pain.
Risks of the procedure:
As with any surgical procedure, complications may occur. Some possible complications of an episiotomy may include, but are not limited to, the following:
Bleeding
Tearing past the incision into the rectal tissues and anal sphincter
Perineal pain
Infection
Perineal hematoma (collection of blood in the perineal tissues)
Pain during sexual intercourse
Problem in urination
Advantages of an Episiotomy:
Although there is pain and discomfort after an episiotomy, there are advantages to having one.
An episiotomy can make the process of delivery much easier and the mother doesn’t need to put in much effort in pushing to deliver the baby.
Your baby can be delivered quickly in certain emergency situations.
There is less trauma to the vaginal tissues. If the skin is allowed to tear, the tear can be jagged and much harder to repair than a clean cut made with scissors. You can also tear in a place that could cause more serious injury in the rectum or anus. Preventing tearing of the muscle ring around the anus is very important as this could lead to later trouble with bowel movements or foecal incontinence.
Tears can take longer to heal than an episiotomy.
How to Care for an Episiotomy
An episiotomy takes about 4—6 weeks to heal depending on the size of the incision, material used for the stitches and the lifestyle of the mother after delivery. By the time the stitches are absorbed, the skin is strong and the edges should not separate.
If you see stitches on your sanitary pad, check your episiotomy with a mirror to make sure the skin is still closed and looks healed.
After you get home, call your doctor:
If you have any signs of infection such as fever and chills, redness, pain or swelling at the incision site that does not get better every day, or you have a foul-smelling discharge or bleeding from the episiotomy site.
If your pain isn’t controlled with the medicines your doctor prescribes.
If you have problems controlling your bowels or bladder that does not go away.
THANKS