| ID | 339 |
|---|---|
| Name | EPISIOTOMY |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | |
| Management | Technique: The operation vaires from an incision about 1 cm. long to one extending the whole length of the perineum but swinging to one side to avoide the anal sphincter. The incision should keep to the midline as far as possible. The operation may be done under epidural anesthesia, pudendal block or by local infiltration with 10ml of lignocaine 1%. The incision is best made during a contraction when the presenting part is distending the perineum. Straight scissors with blunt points are used. The external sphincter ani must not be cut; if the episiotomy needs to be very extensive it should curve out laterally. Repair: Suturing should be done with care. Every effort must be made to avoid unsutured spaces. Repair is done in three layers. A continuous suture with fine chromic catgut (1/0) for the vagina first- the initial stitch should be given at the apex to avoid bleeding & lastly at the muco-cutaneous junction, then intur-rupted sutures for the perineal muscle, and then a sub-cuticular inturrupted suture with chromic catgut (1 or 1/0) for the skin of the perineum. Daily bathing is advised; otherwise the wound is kept as dry as possible and left alone. Mild analgesics are given. |
| Introduction | Episiotomy is a surgically planned incision given in the perineum & posterior vaginal wall to enlarge the vaginal introitus. It usually done during the second stage of labour. The aim of episiotomy- to facilitate easy and safe delivery of the baby; to reduce the incidence of perineal tear and its complication, genital prolapse & stress incontinence. Indications for episiotomy: 1. When ever the perineum threatens to tear. 2. When there is delay in delivery with the head pressing on the perineum. 3. In forceps delivery. 4. In breech delivery- when breech is distending the perineum. 5. Foetal distress-when occurs at the perineal stage of delivery. 6. Prolapse of the cord- if cord prolapses with rupture of the membrane in the 2nd stage of labour. 7. In premature labour. |
| History | |
| Etiology | |
| Clinical Features | |
| Preventions | |
| Treatment | |
| Complications | |
| Prognosis | |
| Types | Types of episiotomy: 1. Medio-lateral: most popularly used method. The incision is made downwards & outwards from the midpoint of fourchette preferably on the right side to avoid injury to the rectum which is directed diagonally in a straight line & runs about 2.5 cm away from the midline in the from of T. 2. Median 3. Lateral |
| Classification | |
| Observation | |
| Pathology |
© Pakistan Drug Directory. All Rights Reserved.
Designed By: Pakistan Drug Directory Team