Episiotomy

An episiotomy is an incision made in the vaginal wall and perineum during the second stage of labor and delivery. The perineum is cut open during surgery to increase vaginal space and assist labor.

Objectives

• To enlarge the vaginal opening for more comfortable and risk-free childbirth.
• In order to prevent the perineal muscles from becoming overstretched and rupturing.
• To reduce pressure on the developing baby's head.
• In order to prevent cuts and rips.

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

1. 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
2. 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

Discretion is required due to the sensitive nature of the episiotomy's timing. Episiotomies involve making incisions in the fourchette, superficial muscles, perineum skin, and posterior vaginal wall skin. Delivery can be sped up only if the presenting component is inserted directly into these tissues. If it's done too quickly, the presenting component won't be released and you can end up with bleeding from the severed vessels. If the surgery is delayed too long, tears and lacerations might result. So, the best timing is when the perineum bulges and thins right before crowing.

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.