steps of episiotomy sutures

 Layers of Episiotomy Suturing

1. Vaginal mucosa and submucosa tissues

2. Perineal muscles

3. Subcutaneous and skin

The episiotomy repair to done in following ordor.

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

Positions

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

Steps of Episiotomy Repair 

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.