EPISIOTOMY
EPISIOTOMY
EPISIOTOMY
Indiction Instrumental delivery Breech delivery To speed up second stage. Suspected big baby shoulder dystocia Tight perineum To prevent extended tear or
Complication Painful- if cut too lateral May extend to 3rd/4th degree tear Infection Poor healing Missed apex of tear may allow continued bleeding Deep suture- fistula formation Too tight suture- later discomfort
1 degree What structures are cut: posterior vaginal wall superficial and deep transverse perineal muscle bulbospongiosus part of levator ani branches of pudendal vessels and nerves subcutaneous tissue
1st layer (vaginal mucosa) Lithotomy position,good light Cleaned perineum, draped, aseptic instrument Local anesthetic
st
nd
Involves vaginal epithelium and vaginal skin only Simply one of two interrupted sutures Involve perineal muscle No anal spincter involve partial or complete distruption of anal sphincer tear to anal sphincter complex and rectal mucosa
2nd layer (perineal muscle) Interuppted sutures Avoid oversuture through rectal mucous 3rd layer (skin and SC) Interuppted/continuou s sutures/ subcuticular