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Assignmenton Episiotomy Care

Episiotomy is a surgically planned incision made in the perineum and posterior vaginal wall during the second stage of labor to facilitate delivery and prevent tearing. It can be median or mediolateral. Indications include a rigid perineum, first-time mother, anticipated tearing, operative delivery, or previous perineal surgery. Post-procedure, the episiotomy wound is sutured and the patient is monitored for complications like hematoma, infection, or laceration.

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9K views5 pages

Assignmenton Episiotomy Care

Episiotomy is a surgically planned incision made in the perineum and posterior vaginal wall during the second stage of labor to facilitate delivery and prevent tearing. It can be median or mediolateral. Indications include a rigid perineum, first-time mother, anticipated tearing, operative delivery, or previous perineal surgery. Post-procedure, the episiotomy wound is sutured and the patient is monitored for complications like hematoma, infection, or laceration.

Uploaded by

Priya
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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EPISIOTOMY

Definition
Episiotomy is a surgically planned incision on the perineum and posterior vaginal wall
performed during the second stage of labor to facilitate delivery.

Purposes
1. To substitute a straight surgical incision for the laceration that may otherwise occur.
2. To facilitate repair of incised area and promote healing.
3. To spare the newborn’s head from prolonged pressure and to avoid pushing against
rigid perineum.
4. To shorten the second stage of labor.
5. To speed delivery if there is any fetal distress.
6. Prior to an assisted delvery such as forceps or ventose extraction.
7. To minimise the risk of intracranial damage.
8. To prevent overstreching of the perineal muscles.

Types
Median or midline- incision made in the middle of the perineum and directed towards the
anus.

Mediolateral- incision begins at the midline and is directed laterally.

Indications

1. Inelastic rigid perineum


2. Primigravida
3. Anticipated perineall tear
4. Operative delivery
5. Previous perineal surgery

Articles
A sterile tray containing

a. Sterile syringe with needle


b. Needle holder-1
c. Episiotomy scissors-1
d. Suture cutting scissors-1
e. Cutting needle-1 for skin, round body needle for muscles
f. Thump forceps
g. Suture material-2-0chromic catgut-1
h. Kidney tray
i. Plain lignicaine 2%
j. Antiseptic solution
k. Sterile gloves
l. 4x4 gauze pieces
m. Tampons

General instructions
1. Ensure that
a. The presenting part is directly applied to the perineal tissues, which will be
evidenced as buldging perineum.
b. Vaginal orifice is distended approximately 3cm diameter of the presenting part
between contractions.
2. The presenting part of the fetus should be protected from injuries
3. The timing of the cut should be such that the lacerations are prevented and
unnecessary blood loss can be prevented and unnecessary blood loss avoided.

Procedure

Sl. No Nursing action Rationale


1. Place the patient on the Gives clear visualization
delivery table in dorsal
recumbent position when the
fetal head is distending the
perineum
2. Infilterate the perineum using
10ml of local anesthetic.Wait
for 3-5 min for the action.
3. Place your index finger and Provides protection to the
middle fingers in the vagina presenting part in two ways:
with palmar side down and a. The fingers are against the
facing you. presenting part and are thick
enough so that the scissors , if
properly placed will not hurt
the baby.
b. The outward pressure directs
the perineal body away from
the baby.
4. Place the blades of the scissors
in straight up and down
position , so that one blade is
against the posterior wall and
and the other blade against the
skin of perineal body with the
point where the blades cross at
the middle of the posterior
fourchette.

5. Adjiust the length of the The length of the incision should be


blades of the scissors on the adequate to deliver the fetal head.
perineal body and predict the
length of the incision
accordingly.
6. a. A mediolateral
episiotomy cut at a
slant, starting at the
midline of the
fourchette with the
points of the scissors
directed towards the
ischeal tuberosity on the
same side as the
incision.
b. A midline episiotomy
cut in the middle of the
central tendinous points
of the perineum from
the posterior fourchette
down to the externall
anal sphincter.
7. If a midline episiotomy was
cut, palapate the external anal
sphincter.
8. Cut again if needed, avoid
snipping.
9. Extend the vaginall side of the Protects the fetal presenting part
incision if needed by incising
the vaginal band. For this, the
scissors must come from
above the backside of the hand
to slide down the fingers and
make the cut.
10. Apply pressure in 4x4 sponges Control any slight bleeding present
11. After completion of delivery
assist for the suturing of the
episiotomy incision.
12. Wipe the wound area with Prevent spread of microorganisms
sterile antiseptic cotton swabs.
13. Focus light on the perineal Give clear visualization of the
area. perineum.
14. Diagnose th edegree of
perineal teat if any.
15. Pack the vagina with tampoon To prevent bleeding
16. Visualize the apex of the
mucosa, start suturing using
round body needle.
17. Repair the perineal muscles by
interrupted sutures
18. Remove the vaginal pack
which was inserted during
suturing
19. Clean the perineum and apply
pads
20. Ask the patient to lie down in Make patient comfortable
supine position
21. Wash and dry the equipments
used
22. Record the time of episiotomy Act as a communication between
performed staff members

After care

1. Check for any bleeding from inner areas or hematoma formation.


2. Check the vital signs.
3. Check for any tear or laceration.

Complication

1. Hematoma
2. Infection
3. Perineal laceration
4. Wound dehiscence
5. Dysparenuia
6. Scar endometrosis

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