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EPISIOTOMY

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EPISIOTOMY Incision that is made with a scissor cause 2nd degree laceration of the vulva, vagina and perineal

body GOAL: To enlarge birth passage in order to facilitate delivery

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

2 degree 3 degree 4 degree


th rd

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

From 1cm above apex and make a knot.


Proceed suturing vaginal mucosa until the introitus with Continuous non-locking stitches, use absorbable suture

2nd layer (perineal muscle) Interuppted sutures Avoid oversuture through rectal mucous 3rd layer (skin and SC) Interuppted/continuou s sutures/ subcuticular

Per vaginal examination, then per rectal examination

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