Types of delivery•normal

•operativeNormal delivery-appropriate term, vertex ,normal

weight of the fetusOperative-incision and instrumental such as

foreceps, ventousCeasarean-fetuses are delivered through the incision of the abdominal and uterine walls

INTRODUCTION

EPISION=PUBES,PUDENTATOMY=CUTTINGPERINEOTOMY

OBJECTIVESAFTER COMPLETION OF THIS PRESENTATION A

LEARNER IS ABLE TO•DESCRIBE THE TYPES OF DELIVERY

•EXPLAIN COMPLETE PROCEDURE OF EPISIOTOMY•ANALISE MERITS AND DEMERITS OF EPISIOTOMY

•EXPLAIN COMPLICATIONS•KNOW THE POST OPERATIVE CARE OF THE WOUND

a

EPISIOTOMY

DEFINITION :- a surgically planned incision on the perineum during the second stage of labor.

PURPOSES:-• To enlarge the vaginalintroitus to facilitate

easy and safe delivery of the fetus .• To minimize over stretching and rupture of

perineal muscles and fascia.• To reduce the stress and strain on the fetal

head.

WHEN•The baby is very large

•The fetal head is too large even in the vertex position

•Fetus is in breech•Rigid perineum

•The operative delivery is recommended-forceps and ventous•Baby’s shoulders r stuck (dystocia)

INDICATIONS

MedianMedio-lateral

Lateral‘J’ shaped

Median:-starts from vaginal opening to anus(straight line)

Medio-lateral:from center of the vagina either to the left or right towards the buttocks angles

45 degreesLateral: incision starts from I cm away from the midpoint of vagina either left or right side‘j’shaped:begins in the vagina and is directed posteriorly for about 1.5cm and then directed downwards and outwards like 5 or 7 ‘o’ clock

TYPES OF INCISIONS

Including 1 Pair disposable complete leg

sleeves. 4 Sterile drapes. 6 Adhesive tapes 2x10cm to attach

drapes and leg covers. 1 Stainless-steel needle-holder 7"

(18cm.) long. 1 Europlas™ scissors sharp/blunt. 1 Eurofor™ insert forceps. 1 Europlas™ curved hemostat. 4 Gauze balls X-Ray detectable. 10 Gauze sponges 10x10cm X-Ray

detectable. 1 Gynecological highly absorbent

"mouse" tampon. 1 Medicine cup 30ml. 1 Syringe 20ml. 1 Needle 18G. 1 Needle 21G.

Directions Direction for use of kit for Episiotomy procedure at childbirth Preparation: The following additional items are required: 1. 1 pr. surgical gloves of suitable size 2. antiseptic solution 3. sutures & suitable needles 4. anesthetics Direction for use: 1. Open the kit, remove the sterile field, & spread over the patient's

abdomen or over any other working area with the polybacked surface facing downwards and the

absorbent paper surface upwards. It is preferable to secure the sterile field with the elastic plasters

to prevent slipping. Use of elastic plaster strips: Gently stretch the plaster lengthways, by using both

hands, until the separation is visible at center cut - then easily remove the silicone paper. 2. Hold the tray on its under surface, & empty its contents onto the sterile

field, taking care to prevent contact of the edge of the tray with the sterile field. Set the tray

aside within easy reach, for use as a container for antiseptic solution during suturing.

3. Fit the disposable leg-sleeves onto the thighs of the patient, securing them with plasters.

4. Spread additional sterile field under the buttocks of the patient, with polybacking facing

downwards, - absorbent surface in contact with the patient's body. 5. Additional sterile drape is for use as an apron or any other covering for the

patient. 6. Remove the sutures aseptically from their first package, and place them on

the sterile field together with the other kit components. 7. Pour antiseptic solution into the kit container. (The compartment is designed

for economy) 8. Put on gloves and mask and commence the suturing procedure. Use the

gauze & cotton tupfers, the "mouse" tampon, hemostats, syringe plus 2 needles, and medicine cup, as

and when required in accordance with your experience in these procedures. 9. During and after the suturing procedure, all refuse must be disposed of in

the suitable containers, including all the instruments - all instruments are for single, one time use only -

for comfort and safety of patients, personnel and doctors

EXPLAIN THE COMPLETE PROCEDURE AND ADVANTEGES↓

LET THE PATIENT LIE DOWN IN LITHOTOMY POSITION WITH GOOD LIGHT↓

LOCAL ANAESTHESIA(10ml of 1% lignocaine)↓

WASH THE PERINEUM↓

PLACE 2 FINGERS BETWEEN THE VAGINAL WALL AND THE HEAD OF THE FETUS↓

2-3cm INCISION IS MADE↓

DELIVER THE CHILD

PROCEDURE-STEPS

↓WIPE AND WASH AWAY THE BLOOD CLOTS ON THE

PERINEUM ↓SUTURING WITH POLY GLYCOLIC ACID SUTURE AND ‘O’

CHROMIC CATGUT

DRESSING:-EACH TIME FOLLOWING URINATION&DEFECATION(IS DONE BY SOAKING OF ANTISEPTIC SOLUTION FOLLOWED BY APPLICATION

OF ANTISEPTIC POWDER OR OINTEMENT(FURACIN OR NEOSPORIN)

COMFORT:-MAGNESIUM SULFATE COMPRESS OR INFRARED HEAT, ANALGESIC MAY BE USED .

AMBULATION:-ALLOW THE PATIENT TO MOVE OUT OF BED AFTER 24 HRS.

REMOVAL OF STITCHES:-IF THE WOUND IS SUTURED BY CATGUT OR DEXON IT WILL BE ABSORBED BUT

SILK OR NYLON NON ABSORBABLE MATERIAL SHOULD BE REMOVED ON 6 TH DAY.

POST OPERATIVE CARE

INFECTIONHEMORRHAGE

PAINPAIN WITH INTER COURSE.

IRREGULAR BOWEL FUNCTION.

COMPLICATIONS

MERITS DEMERITS

THE PERINIAL MUSCLES ARE NOT CUT.

REPAIR IS EASY.HEALING IS

FASTER.WOUND

DISRUPTION IS RARE.

INJURY TO THE RECTUM.

BLOOD LOSS IS MORE.

DYSPAREUNIA.INJURY TO THE

BARTHOLIN’S DUCT.

RESEARCH ABSTRACTThroughout the rest of the 20th Century, episiotomy was

considered the standard of care by many American obstetric care providers. By 1979, episiotomy was performed in approximately 63% of all deliveries in the USA, with higher rates among nulliparas. In the UK in the same era, episiotomy rates ranged from 14 to 96% among nulliparas and 16–71% among multiparas.The purported short-term benefits for the parturient included its ease of repair compared with a spontaneous perineal laceration, improved postpartum pain and reduction in severe (third and fourth degree) lacerations. Additional long-term benefits were believed to accrue from decreasing the time that the perineum is stretched during birth, including prevention of pelvic floor relaxation, pelvic organ prolapse, sexual dysfunction, and urinary and fecal incontinence. The purported benefits to the neonate included prevention of asphyxia, cranial trauma, cerebral hemorrhage and mental retardation, as well as reduction in the incidence of shoulder dystocia.

SUMMARYTypes of deliveriesObjectives.Episiotomy definition and procedure.Post operative care.Complication.Merits and demerits.Research abstracts.

BYN.GEETHA REDDY

MS(N)

EPISIOTOMY