DEMONSTRATION ON EPISIOTOMY

COMMUNITY BAG

INJECTION ARTERY FORCEP

EPISIOTOMY SCCISSOR SUTURE CUTTING SCCISSOR

CHROMIC CATGUT THUMB FORCEP

CATGUT KIDNEY TRAY

LIDOCAINE 2% BETADINE SOLUTION

STERILEGLOVES GAUZEPICE
 EPISIOTOMY AND SUTURING
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 delivery table Gives clear visualization
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 middle Provides protection to the
fingers in the vagina with palmar side presenting part in two ways:
down and facing you. a. The fingers are against the
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 blades of the The length of the incision should be
scissors on the perineal body and adequate to deliver the fetal head.
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 incision Protects the fetal presenting part
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 sterile Prevent spread of microorganisms
antiseptic cotton swabs.
13. Focus light on the perineal area. Give clear visualization of the
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 supine Make patient comfortable
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
BIBLIOGRAPHY
1. Dutta D. C.. “Textbook of Obstetrics”, 1st Edition, Jaypee Brothers Medical Publisher
(P) Ltd, Pg.145-153.
2. Shyamala D, manivannan , Text book of community medicine 1st edition 2017, Satish Kumar
jain publisher, CBC publication and distributors , 4596/ Daryanganj , new Delhi page no- 47-
57