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

Timings-
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.

Types-
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

Repair-
Chromic catgut Or Vicryl

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

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