Episiotomy: Reasons, Types, Risks, Care & Healing

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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.

2- Mediolateral:

  • 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.

Note :
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.

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