Episiotomy

Prepared by:

Dr. Kasturi Malla

Senior Consultant Gynecologist &
Obstetrician: Government of Nepal
Visiting Professor: CTGU
February,2009
 Defn.:-

Incision
over the perineum and posterior vaginal wall
in 2nd stage of labor
in order to
ease the delivery of fetus by enlarging vaginal
introitus and
prevent the tear of perineal muscle and fascia.

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 Indication

 Tight perineum  Big baby

 Shoulder dystocia  Face presentation

 Instrumental delivery  Breech presentation

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 Timing

 Thinned out and bulged perineum

 During contraction

 At crowning or just prior to it

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 Types

 Posterior  Anterior
ll
1. Mediolateral Anterior scarotomy

2. Median

3. Lateral

4. ‘J’ shaped

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 Types of Episiotomy

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 Structures cut(6)
1. Posterior vaginal wall

2. Perineal muscles

*Superficial transverse perineal m.

*Deep transverse perineal m.

*Bulbospongiosus m.

*(Part of) Levator ani m.

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 Structures cut(6)

3. Fascia covering perineal muscles

4. (Transverse perineal branches of) Pudendal

vessels and nerve

5. Subcutaneous tissue

6. Skin

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 Repair

1. TimingSoon after delivery

2. Position Lithotomy
3. Sterile gloves
4. Antiseptic cleansing
5. Sterile draping
6. Local anesthesia
7. Removal of vaginal clots and blood

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 Suture in 3 layers

1stVaginal mucosa and sub mucosal tissue

2ndPerineal muscles

3rdSkin and sub cutaneous tissue

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 Principle of repair

1. Assure anatomical apposition

2. Maintain hemostasis

3. Obliterate dead space

4. Suture without tension

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