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
To study about :-
 Introduction
 Definition
 Objectives
 Indication
 Advantages
 Types of episiotomy
 Enlisting equipments
 Preparation of patient
 Making episiotomy
 Complications
 After care
 Health education
 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
 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.
 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
Large size baby
Preterm delivery
Shoulder dystocia
Malpresentation
Unable to respond
to the instructions
1. Maternal:-
 Aclearandcontrolledincisioniseasytorepairandhealsbetterthan
laceratedwoundthatmightoccurotherwise.
 Reductioninthedurationofsecondstage
2. Fetal:-
 Minimize intracranial injuries specially in
premature babies
 Helps to conduct breech delivery
There are 4 types of episiotomy-
 Mediolateral
 Median
 Lateral
 J shaped
 The incision commences
from the center of the
fourchette and extends
along posteriorly along
the midline for about
2.5cm
 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
 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
 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
 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
 Ensure good lighting
 Check the equipment before starting the
procedure
 Provide screening
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
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
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
step:-1 Preliminaries:
 The perineum is thoroughly
with antiseptic lotion,
 Draped properly,
 Incision line- Infiltrated with 10 ml
lignocaine solution.
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
 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
 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 .
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
 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
 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.
Immediate care
◦Inspect the repair to check hemostasis
has been achieved
◦Account for all instruments, swabs and
needle
◦Discard sharp needle safely
 Apply Sterile pad following through
perineal wash
 Wait for minimum one hour to shift
patient to ward
 Check for bleeding and urine output
Post operative care
1. Dressing
2. Comfort
3. Ambulance
4. Removal of stitches
 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
 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
Episiotomy procedure
Episiotomy procedure
Episiotomy procedure

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, alsoknown 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 surgicallyplanned 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 enlargethe 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
  • 9.
  • 10.
  • 11.
  • 12.
  • 13.
    Unable to respond tothe instructions
  • 14.
  • 15.
    2. Fetal:-  Minimizeintracranial injuries specially in premature babies  Helps to conduct breech delivery
  • 16.
    There are 4types of episiotomy-  Mediolateral  Median  Lateral  J shaped
  • 17.
     The incisioncommences from the center of the fourchette and extends along posteriorly along the midline for about 2.5cm
  • 18.
     The incisionis 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 incisionstarts 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 incisionbegins 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’sorder  Establish rapport with patient  Ensure that women consents to the procedure  Provide comfort to patient  Explain in short about the procedure
  • 22.
     Ensure goodlighting  Check the equipment before starting the procedure  Provide screening
  • 24.
    Kidney tray Tocollect 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 Tohold 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 syringeFor 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:  Theperineum 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 incisionshould 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 vaginalwall  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 ofrepair:- 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 repairshould 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.  Tearinginto 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 therepair to check hemostasis has been achieved ◦Account for all instruments, swabs and needle ◦Discard sharp needle safely
  • 39.
     Apply Sterilepad 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 adiet 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 ina 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