Episiotomy procedure
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The document presents a comprehensive study on episiotomy, a surgical incision performed during the second stage of labor to facilitate childbirth. It outlines the definition, objectives, types, complications, and aftercare associated with the procedure. Detailed procedural steps, required equipment, and health education for patients are also provided.
Episiotomy procedure
- 1. Presented By:- Ms.Samiksha singh Bsc(n) Iv th year Era college of nursing Guided By:- Dr.Anjalatchi Muthukumaran Vice principal Era college of nursing
- 2. To study about :- Introduction Definition Objectives Indication Advantages Types of episiotomy
- 3. Enlisting equipments Preparation of patient Making episiotomy Complications After care Health education
- 4. Episiotomy, also known as perineotomy It is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician Which is usually performed during second stage of labor to quickly enlarge the opening for the baby to pass through
- 6. A surgically planned Incision on the perineum and posterior vaginal wall during the second stage of labor is called episiotomy An episiotomy is a cut (incision) through the area between your vaginal opening and your anus. This area is called the perineum. This procedure is done to make your vaginal opening larger for childbirth.
- 7. To enlarge the vaginal introits so as to facilitate easy and safe delivery of the fetus To minimize overstretching and rupture Of the perineum muscle to reduce the stress and strain on the fetal head
- 12. Malpresentation
- 13. Unable to respond to the instructions
- 14. 1. Maternal:- Aclearandcontrolledincisioniseasytorepairandhealsbetterthan laceratedwoundthatmightoccurotherwise. Reductioninthedurationofsecondstage
- 15. 2. Fetal:- Minimize intracranial injuries specially in premature babies Helps to conduct breech delivery
- 16. There are 4 types of episiotomy- Mediolateral Median Lateral J shaped
- 17. The incision commences from the center of the fourchette and extends along posteriorly along the midline for about 2.5cm
- 18. The incision is made downwards and outwards from the midpoint of the fourchette either to the right or to the left It is diagonally in a straight line which runs about 2.5 Cm away from thre anus
- 19. The incision starts from about 1cm away from the center of the fourchette and extends laterally It has drawbacks like chances of injury to the Bartholins duct
- 20. The incision begins in the center of the fourchette and directed along the midline for about 1.5cm and then directed downwards and outwards along 5 or 7 O’clock position to avoid anal sphincter This is not done widely
- 21. Check doctor’s order Establish rapport with patient Ensure that women consents to the procedure Provide comfort to patient Explain in short about the procedure
- 22. Ensure good lighting Check the equipment before starting the procedure Provide screening
- 24. Kidney tray To collect the waste material Pair of gloves To prevent the infection Gauze swabs To wipe the blood Needle holder To hold the needle while suturing
- 25. Sponge holder To hold the Gauze pieces ALLIS FORCEP To hold heavy tissue Artery forcep To control bleeding Lignocaine % Local anesthetic Catgut suture To repair the episiotomy Episiotomy Scissors For incision
- 26. 10 ml syringe For administration of anesthesia Adson forcep To provide hemostasis Sponge holder To hold the cervix to see if there is any cervical tear
- 28. step:-1 Preliminaries: The perineum is thoroughly with antiseptic lotion, Draped properly, Incision line- Infiltrated with 10 ml lignocaine solution.
- 29. Step :-2 Incision Two fingers are placed in vagina between the presenting part and the vaginal wall The incision is made by curved or straight blunt pointed sharp scissor or scalpel One blade of which is placed inside , in between the fingers and the posterior vaginal wall and the other on the skin
- 30. The incision should be made at a height of uterine contraction Deliberate cut should be made starting from the center of the fourchette extending laterally either to the right or to Left. It is directed diagonally in a straight line which runs about 2.5cm away from the anus
- 31. Posterior vaginal wall Superficial and deep transverse perineum muscle Fascia covering those muscles Transverse perineum branches of pudendal vessels and nerves Subcutaneous tissue and skin .
- 33. Step:-3 REPAIR Timing of repair:- soon after expulsion of placenta Preliminaries:- The patient is placed in lithotomy position A good light source Clean the perineum area and wound with antiseptic solution Remove the blood clots from vagina and wound area
- 34. The repair should be done under strict aseptic precautions The repair is done in three layers :- Vaginal mucosa and submucosal tissue Perineal muscles Skin and subcutaneous tissue
- 37. Bleeding. Tearing into the rectal tissues and anal sphincter muscle which controls the passing of stool. Swelling. Infection. Collection of blood in the perineal tissues. Pain during sex.
- 38. Immediate care ◦Inspect the repair to check hemostasis has been achieved ◦Account for all instruments, swabs and needle ◦Discard sharp needle safely
- 39. Apply Sterile pad following through perineal wash Wait for minimum one hour to shift patient to ward Check for bleeding and urine output
- 40. Post operative care 1. Dressing 2. Comfort 3. Ambulance 4. Removal of stitches
- 41. Eat a diet high in Fiber and fluid to prevent constipation Ask the women to walk with thigh apposed Not to use squatting position since wound is healing Change sanitary pad at least every 4 hours to help prevent infection
- 42. Sit in a tub of warm water Always wash hands before and after going to bathroom Always keep the wound clean and dry after each urination and defecation