MIDWIFERY AND OBSTETRICAL
TOPIC:- EPISIOTOMY
PREPARED BY :- PAYAL T VAGHELA
ASSISTANT PROFESSOR
NOOTAN COLLEGE OF NURSING
VISNGAR
2

 OUTLINES:-
• Definition
• Benefits of episiotomy
• Types of episiotomy
• Timing of episiotomy
• Indications of episiotomy
• Repair of an episiotomy
• Postoperative care
• side effects

 DEFINITION OF EPISIOTOMY:-
Episiotomy may be defined as an
incision on the perineum (the area of the skin
between the vagina and the anus) to enlarge
the vagina introits to facilitate the passage of
the fetal head and prevent uncontrolled tear
of the perineal tissues.

 BENEFITS OF EPISIOTOMY:-
• Prevent tearing of the perineum.
• Protect against incontinence.
• Speed up the birth in second stage.
• Protect against pelvic floor relaxation.
• less painful.

 TYPES OF EPISIOTOMY:-
TYPES OF
EPISIOTOMY
MIDELINE
EPISIOTO
MY
MEDIOLAT
ERAL
EPISIOTO
MY
J SHAPED
EPISIOTO
MY
LATERAL
EPISIOTOMY

1) MEDIAN OR MIDLINE
EPISIOTOMY:-
• The incision is made in the midline.
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2) MEDIOLATERAL EPISIOTOMY:-
• The incision begins in the midline, but is
directed downward and laterally, away, from
the rectum.
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3) J SHAPED EPISIOTOMY:-
• The downward tip of the cut is curled away
from the rectum.
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4) LATERAL EPISIOTOMY:-
• Episiotomy performed laterally in 3 or 4 6
o’clock position is a lateral position.
• It is generally avoided because of increased
blood loss.
• It is also difficult to appose correctly during
repair.
• In our country ,the mediolateral episiotomy is
common.
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 EQUIPMENTS :-
• Sterile drape
• Sterile gown and gloves
• Gauze swabs and tampon
• Needle holder
• Sponge holder
• Scissors, 10 ml syringe
• Toothed forceps
• Suture material
• 1% lignocaine
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 REPAIR OF AN EPISIOTOMY:-
• It is the best to performed repair of the
episiotomy wound after the placenta is
delivered.
• The vaginal mucosa is suture first, followed by
approximation of perineal muscles.
• The skin may be closed by interrupted
mattress or subcuticular stitches.
• Although the newer suture materials give a
better postoperative recovery, one may have
to remove an occasional suture which may not
dissolve and cause chronic irritation.

 TIMING OF EPISIOTOMY:-
• Normally, episiotomy is performed when the
head is distending the perineum and is about
to crown or at least 3 to 4 cm of the diameter
of the head is visible.
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 INDICATIONS OF EPISIOTOMY :-
• In all primigravidae undergoing vaginal delivery
,most women having their first baby, were
subjected to an episiotomy.
• To straight proper surgical incision and clean
repair.
• Mothers in labour having the following
difficulties are always subjected to an episiotomy.
ex: Breech delivery
Operative vaginal delivery
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 POSTOPERATIVE CARE:-
• Postoperative antibiotics may be given,
especially if there is extension of the wound
near the anus.
• Local heat and pain killers may be given to
reduce pain in the first few days of
puerperium.
• A stool softener may be given to discomfort
during defection.
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 SIDE EFFECTS:-
• Infection
• Increased pain
• Longer healing times
• Increased discomfort when intercourse is
resumed.
• Increased in third and fourth degree vaginal
lacerations.
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THANK YOU
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