Episiotomy or Perineotomy is a surgical cut equivalent to the second degree perineal tear, made at the opening of the vagina during second stage of labour, to aid delivery and prevent rupture perineum and the surrounding tissues.
Indications:
Clean incision is easier to repair than a jagged tear and may heal faster
Procedure:
1. Local anesthetic is given (B)
2. Perineum is cut in angle with scissor (C). 2 types:
Complications:
Indications:
- Maternal or fetal distress
- Premature baby or Breech presentation
- Large fetus
- Instrumental delivery is indicated
- Mother is too tired and unable to push
- Existing trauma to the perineum
Clean incision is easier to repair than a jagged tear and may heal faster
Procedure:
1. Local anesthetic is given (B)
2. Perineum is cut in angle with scissor (C). 2 types:
- Medio-lateral: The incision is made downward and outward from midpoint of fourchette either to right or left. It is directed diagonally in straight line which runs about 2.5 cm away from the anus (midpoint between anus and ischial tuberosity).
- Median: The incision commences from centre of the fourchette and extends on posterior side along midline for 2.5 cm. The disadvantage is that it may extend to involve the anal sphincter.
Complications:
- Bleeding
- Infection
- Swelling
- Defects in wound closure
- Local pain
- Urinary incontinence
- Pain during sexual intercourse
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