Episiotomy: Reasons, Types, Risks, Care & Healing
Episiotomy: an incision made in the perineum to enlarge the vaginal outlet.
It serves the following purposes :
Episiotomy Prevent tearing of the perineum, substitute a straight surgical incision for the laceration that may otherwise occur.
- Facilitate repair of laceration and promote healing.
- Minimize prolonged and severe stretching of the muscles supporting the bladder or rectum which may later lead to stress incontinence or vaginal prolapse.
- Shorten the second stage, which may be important for maternal reasons as, PIH or fetal reasons for persistent bradycardia.
- Enlarges the vagina in case manipulation is needed to deliver an infant for example in breech presentation or for application of forceps.
There is two types of Episiotomies:
The type of episiotomy is designated by the site and direction of the incision
1- Median: Is one most commonly employed?
- It is effective, easily repaired and generally the least painful.
- The incision is made in the middle of the perineum and directed toward the rectum.
- Is believed to heal with few complications, more comfortable for the women.
- If a long and large incision is needed during delivery, it may necessitate incision into the anal sphincter.
- The incision is made laterally in the perineum.
- This method avoids the anal sphincter if enlargement is nodded.
- The blood loss is greater, the repair is more difficult.
Assessment the site:
- The episiotomy site is inspected every 15 minutes during the first hour after delivery, then on a daily basis.
- The site is assessed by tenderness, redness, swelling and evidence hematoma (collection of blood in the perineal tissues).
- Pain during sex after a long time.
Because suture used to repair episiotomy are of absorbable material they don’t need to be removed and no dressing is applied.
The site should also be cleaned a after urination and dry.