An episiotomy is a surgical procedure to widen the opening of the vagina during childbirth. During labor, your perineum — the skin and muscles between your vagina and anus — will be numbed with a shot, if you haven't already been given an epidural. Then, a small, straight incision will be made in the middle of the perineum. Alternatively, the incision may be made at an angle — a cut that is less likely than a straight incision to tear through the anus, but may take longer to heal.

1. EPISIOTOMY
SUTURE/REMOVAL/CARE
Presented BY-
Ms. Anshika Shukla
B.sc Nursing 4th Year
Era’s College Of Nursing
Guided BY-
Dr. Anjalatchi
Vice Principal
Era’s College Of Nursing

2. Content to be learned
• Introduction
• Definition
• Objective
• Indication
• Contra indication
• Advantages
• Disadvantages

3. Continued
• Types
• Equipments
• Steps of Episiotomy
• Repair steps
• Postoperative care
• Complications
• Summary
• Bibliography

4. INTRODUCTION
• Episiotomy is asurgical incision Of the perineum performed to
widen the vaginal opening for the delivery of an infant .An
Episiotomy is cut with scissor as theinfant head is crowning .

5. DEFINITIO N
• A surgically planned incision on the perineum and the
posterior vaginal wall during the second stage of
labor is called Episiotomy (perineotomy).

6. OBJECTIVES
• To enlarge the vaginalintroitus so as to facilitate
easy and safe delivery of the fetus.
• To minimize over stretching and rupture of the
perineal muscles to reduce the stress and strain on
the fetal head.

7. INDICATIONS
• In elastic (rigid) perineum :-causing arrest ordelay in descent of the presenting
part as in elderlyprimigravidae
• Anticipatingperinealtear :-big baby
,face to pubis delivery,breechdelivery,shoulder
dystocia.
• Operative delivery :-forcepsdelivery
• Previousperinealsurgery :- perinealreconstructivesurgery.

8. COMMON INDICATIONSARE
• Threatened perineal injuryin primigravidae.
• Rigid perineum
• Forceps,breech occipitoposterioror face delivery.

9. CONTRAINDICATIO
NS
• Abnormalities of theperineum
• Inflammatory boweldisease
• Severe perinealscarring
• Perinealmalformation

10. TIMING OF THE EPISIOTOMY
• Bulging thinned perineum during contraction just
prior to crowning (when 3-4cm of head is visible) is
the ideal time.

11. TYPE
S
1 Mediolateral
2 Median
3 Lateral
4 ‘J’shaped

12. MEDIOLATERAL
• The incision is made downwards andoutwardsfrom the midpointof the fourchette
eitherto the rightor left.It is directed diagonallyin a straightline whichruns about
2.5 cm awayfrom theanus
MEDIAN
• The incisioncommencesfromthe centre of the fourchetteandextends posteriorly
along the midlinefor about2.5cm.

13. LATERA
L
• The incision starts from about1cm awayfrom the center of the fourchette and
extends laterally. It has got many drawbacks including chance of injury to the
bartholinsduct.
JSHAPED
.The incision begins in the center of the fourchette and is directed posteriorly
along the midline for about 1.5cm and then directed downwards and outwards
along 5 or 7 O ‘clock position to avoid the analsphincter.

15. ADVANTAGES
Maternal :-
-A clear and controlled incision is easy to repair and heals better than a
lacerated wound that might occurotherwise.
- Reduction in the duration of second stage.
-Reduction of trauma to the pelvic floor
muscles Fetal :-
-It minimizes intracranial injuries specially in premature babies or
aftercoming head of breech.

16. DISADVANTAGE OF
EPISIOTOMY
• Blood loss
• Difficulty duringsuturing
• Painfulanddiscomfortablepostpartumperiod
• Dyspareunia

17. ARTIC
LES
• Episiotomyscissors
• Surgicaldrape
• Needle holder.
• Stitches
• Tissueforcep
• Syringe
• Vulsellum
• Kidneytray
• Local anesthesia

18. PREPARATION OF THE PATIENT
Preparation of Patient:
1. Explain procedure to the patient.
2. Provide privacy by screens and drapes. Drape the patient as for vaginal examinations.
3. Remove all articles that may interfere with the procedure e.g. air cushion.
4. Give extra pillows to raise the head.
5. Roll the draw sheet to opposite side to prevent soiling when bedpan is placed under buttocks, over draw sheet.

19. Continued
6. Offer bed pan. Keep the clean bed-pan on the bed on your working side.
7. Untie the pads, if any and observe the discharges its color, odor, amount etc.
8. Leave the patient for sometime so that she may pass urine or stool if necessary.
9. Get the toilet tray and arrange the articles conveniently on bed side table.

20. STEPS OF EPISIOTOMY
• Provide emotional support and encouragement
• Use local infiltration with lignocaine
• Make sure there are no known allergies to lignocaine
or related drugs

29. CON
T…
• Apply ice packs right after the birth
• Using ice packs in the first 24 hours after birth
decreases the swelling and and helps with pain
• Take warm baths but wait until 24 hrs after giving birth
• Make sure that the bathtub is cleaned with a disinfectant
before every bath

33. SUMMARY
• Episiotomy is an incision in the perineum carried out during the
second stage of labor to facilitate the birth of an infant .It is an
important surgical procedure with physiological,psychological,and
socio-economic effects on women.

34. BIBLIOGRAPHY
• DC Dutta’sTextbook of obstetrics,Hiralal konar
.Midwifery and obstetrical nursing by Sandeep kaur
.J.Myles ‘the textbookof midwifery 16th edition
.Https://:www.Slide share. Net.com
.Https://:medlineplus.gov
.