Episiotomy

Subject: Midwifery II (Theory)

Overview

When the time comes for an incision to be made in the perineum and the posterior vaginal wall during the second stage of labor, this procedure is known as an episiotomy. To help in labor, the vagina is enlarged with a surgical incision across the perineum. Episiotomy is performed to alleviate tension and pressure on the fetal head, to increase the vaginal aperture to help in smooth and safe childbirth, to reduce the risk of perineal muscle overstretch and rupture, and to prevent lacerations and tears. There are several reasons to choose for an episiotomy, including a difficult vaginal delivery, fetal distress, early birth, cord prolapse, or a very big baby. It's helpful because it prevents the perineum from being overstretched, shortens the second stage, and is simpler to heal than a lacerated wound.

An episiotomy is an incision made in the vaginal wall and perineum during the second stage of labor and delivery. With the goal of making vaginal birth easier, a surgical incision is created through the perineum.

Objectives:

  • to widen the vaginal opening in order to promote simple and secure deliveries.
  • to prevent rupture and overstretching of the perineal muscle.
  • to relieve the fetal head's pressure and strain.
  • to prevent tears and lacerations.

Indication

  • Complicated vaginal delivery
  • Fetal distress
  • To get more space for operative delivery
  • To cut short the 2nd stage
  • A premature baby
  • Cord prolapse
  • Big baby

Advantages

  • Maternal
    • A clean and controlled incision is easier to treat and heals more quickly than a lacerated wound.
    • It keeps the perineum from overstretching.
    • Laceration that extends to the rectum can be avoided.
    • Shortening of the second stage.
       
  • Fetal
    • Reduce intracranial damage, particularly in premature babies.
    • - Cut down on fetal asphyxia.

Disadvantage

  • Hurtful wound
  • Infection and vulval hematoma
  • Blood loss from epi wound: 100-200 mL.
  • Dyspareunia as a result of overstretching

Timing of the Episiotomy

The timing of the episiotomy requires discretion. Episiotomies involve cutting through the fourchette, superficial muscles, perineum skin, and posterior vaginal wall skin. The presenting component can only hasten delivery if it is inserted directly into these tissues. If done too quickly, blood loss from damaged vessels is possible and the presenting component will not be released. In the event that the surgery is carried out too late, tears and lacerations may develop. This means that the optimal time to crowing is just before the perineum begins to swell and thin.

Types of Episiotomy

  1. Mediolateral
    The incision is made downward and outward from the fourchette's midpoint, either to the left or right. It is angled diagonally in a straight line 2.5 cm away from the anus.
  2. Median
    The incision begins in the center of the flechette and extends for about 2.5cm posteriorly along the center.
  3. Lateral
    The incision begins about 1 cm away from the fourchette's center and spreads laterally. It has a number of disadvantages, including the possibility of damaging the Bartholin duct. It is completely condemned.
  4. J shaped
    To avoid the anal sphincter, the incision begins in the center of the fourchette and is directed posteriorly along the midline for about 1.5 cm before being directed downward and outward along with the 5 or 7 o'clock position. This is likewise not generally practiced.

 
Things to remember
  • In the second stage of labor, an episiotomy is performed, which entails an incision in the perineum and posterior vaginal wall.
  • With the goal of making vaginal birth easier, a surgical incision is created through the perineum.
  • Episiotomy is performed to alleviate tension and pressure on the fetal head, to increase the vaginal aperture to help in smooth and safe childbirth, to limit perineal muscle overstretching and rupture, and to prevent laceration and tear.
  • Episiotomies are performed for a variety of reasons, including preterm birth, cord prolapse, fetal distress, or the size of the neonate.
  • An advantage of this method is that it reduces the likelihood of perineum overstretching, shortens the second stage, and facilitates faster healing than a lacerated wound.
  • The episiotomy needs to be performed with discretion due to the time.
  • Episiotomies involve cutting through the fourchette, superficial muscles, perineum skin, and posterior vaginal wall skin.
  • Medial, lateral, and J-shaped episiotomies are the four main types.
Questions and Answers

Episiotomy

  • Episiotomy refers to the surgically planned incision of the posterior vaginal wall and perineum during the second stage of labor.
  • A procedure that involves cutting through the perineum to enlarge the vagina and facilitate childbirth.

Objectives

  • To make the vaginal orifice larger in order to facilitate a simple, secure birth.
  • In order to prevent perineal muscle rupture and overstretching.
  • To lessen the strain and tension on the fetal head.
  • To avoid tearing and lacing.

Advantages

Maternal

  • A clean and controlled incision is easy to repair and heal better than a lacerated wound.
  • It prevents overstretching of the perineum.
  • Laceration extending to rectum can be avoided.
  • Shortening of 2nd stage.

Fetal

  • Minimize intra cranial injuries specially in premature babies.
  • Reduce fetal asphyxia.

Disadvantage

  • Painful wound.
  • Vulval haematoma and infection.
  • Blood loss 100-200 ml from epi wound.
  • Dyspareunia due to over stitching.

Types of Ppisiotomy

  • Medio lateral

The incision is made downward and outward from the mid point of the fourchette either to the left or right. It is directed diagonally in a straight line which runs 2.5 cm away from the anus.

  • Median

The incision commences from the centre of the flechette and extends posteriorly along the middle for about 2.5cm.

  • Lateral

The incision starts from about 1 cm away from the center of the fourchette and extends laterally. It has got many drawbacks including a chance of injury to the Bartholin duct. It is totally condemned.

  • J shaped

The incision begins in the center of the center of the fourchette and is directed posteriorly along the midline for about 1.5 cm and then directed downward and outward along 5or 7 o' clock position to avoid the anal sphincter. This is also not done widely.

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