Episiotomy | Perineotomy

Episiotomy is a planned incision on the perineum and in the posterior vaginal wall during the second stage of labor to ease the delivery whether it is spontaneous or by manipulative means.

Indications –
1. Big baby
2. Rigid perineum in elderly primigravida
3. Breech presentation
4. Shoulder dystocia
5. Forceps & ventouse application
6. Persistent OP position

At the peak of uterine contractions when the head is visible about 3-4 c.m., just before the crowning, & the perineum becomes thinned & bulging is the ideal time to give an incision.

1. Median
2. Mediolateral
3. Lateral
4. J shaped
5. Inverted T shaped

Mostly performed is mediolateral type.

Structures to be cut in episiotomy –
(1) Posterior vaginal wall
(2) Superficial and deep transverse perineal muscles
(3) Bulbospongiosus (Rarely levator ani)
(4) Perineal vessels and nerves
(5) subcutaneous tissue and skin

Chromic catgut Or Vicryl

1. Vaginal mucosa sutures first
2. Perineal muscle
3. Skin & subcutaneous tissue

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