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EPISIOTOMY

Introduction
An incision that has
been said to decrease
trauma to the fetus,
decrease the frequency
of extensive perineal
tears, and protect the
maternal soft tissues.
Before repairing an episiotomy.
Examine the vagina and perineum systematically for
any extension of the episiotomy and for any separate
lacerations.
Do a per rectum examination to exclude anal
sphincter injury.
Ensure that analgesia, lighting and visualization are
adequate
Important Principles of Suturing Episiotomy
1. The apex must be visualized
2. Dead space must be closed
3. Tissues should be brought together but not
strangulated by excessive tension on the sutures
4. Haemostasis must be obtained

Steps in repairing an
episiotomy wound
Step 1
Place a suture 1 cm above
the apex of the incision.
Close the vaginal epithelium
with continuous sutures up
to the hymenal ring.
Avoid placing sutures in the
mucocutaneous portion of
the fourchette in order to
avoid postpartum
dyspareunia
Step 2
Close muscle with
interrupted sutures
The aim of bringing the
muscles together firmly is to
eliminate any dead space
When the muscles have
been correctly sutured, the
cut edges should be lying
close together.
Remember



sutures should be at 90 to the line of wound
not to put a suture through the rectum

Step 3
Use interrupted sutures
to repair the skin
Do not pull the sutures
tightly

Step 4
Remove pad from the
vagina
Put a finger into the
rectum and feel if a
suture has been placed
through the rectal wall

Episiotomy Wound Dehiscence
Signs to look for.
Inspection:-
Redness
Swelling
Shiny skin
Discharge from wound
Gapping wound wound
breakdown
Slough
Necrotic tissue
Asymmetry



Palpation
Warm
Tender
Tense
Fluctuant
Others
Foul smelling
Infected episiotomy wound
(Day-3 Post-delivery)
Area of slough
Infected episiotomy wound
(Day-7 Post delivery)

Area of slough
and redness
Infected episiotomy wound
(Post delivery day 7)
Gaping wound
secondary to
infection
Badly infected wound
Necrotising fascitis complicating
infected episiotomy wound
Care of Episiotomy Wound
Avoid touching the open wound
Use ice packs to reduce pain and swelling
Use running water to clean the perineum and
vagina after urinating or defecating. Pat the
area dry from front to back
Sitz bath to soothe the perineum and help
to cleanse the wound.




To stimulate healing
From day 1, mobility and changes of position, flexion and
pointing of feet ( prevention of thrombosis)
Normal well balanced eating to accommodate both breast
feeding and demands of healing.
Extra fluid - avoid constipation (straining)
Breathing effectively (to increase supply of 0 to damaged
tissues)
Deep transversus abdominal and back work - pulling in,
correcting posture
Pelvic floor exercises - slow and fast twitch (improves perfusion)
Relaxation, massage, other alternatives
References
1. International Association for Maternal &
Neonatal Health
2. Global Library of Womens Health