Steps of Episiotomy
Steps of Episiotomy involved;
Perineal infiltration and,
Cutting perineal
Step 1
1. Use local infiltration with lignocaine (10ml) 1% solution.
Make sure not allergic 5o lignocaine
2. Infiltrate beneath the vaginal mucosa, beneath the skin of perineum and deeply into the perineal muscles.
3. Wait to perform episiotomy
Step 2
1. Perineum is thinned out and
2. 3-4cm of baby head is visible during contraction
3. Wearing surgical gloves, place two finger between the baby's head (presenting part) and the perineum (posterior vaginal wall).
4. Use episiotomy suture to cut perineum that 3-4cm in medio-lateral direction when uterine contraction occurs and perineum stretched.
Or
Use episiotomy scissors to cut 2-3 cm up the middle of the posterior vagina.
Step 3
Timing of repair
1. Repair done soon after expulsion of placenta.
2. Oozing during this period controlled by pressure with sterile gauze swab.
3. Early repair prevent sepsis and infection
Step 4
1. Lithotomy position
2. Cleaned with antiseptic solution
3. Blood clots removed from vagina and wound area
4. If the repaired fill oozing of blood, vaginal pack inserted and placed thigh up
Repair 5
Vaginal mucosa first sutured
First suture at place at or just above apex of tear.
Vaginal wall sutured done interrupted or continuous sutures with chromic catgut no. "0" downward till the fourchette is reached.
Suture include deep tissues muscle.
Continuous suture may cause shortening of posterior vaginal wall.
Suture with care not to injure rectum.
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