Definition-An episiotomy is a surgical cut in the muscular area between the vagina and the anus (the area called the perineum) made just before delivery to enlarge your vaginal opening.
Obstetricians used to do episiotomies routinely to speed delivery and to prevent the vagina from tearing, particularly during a first vaginal delivery, in the belief that the “clean” incision of an episiotomy would heal more easily than a spontaneous tear. Many experts also believed that an episiotomy might help prevent later complications, such as incontinence.
Indications:-
1. Large size baby:-a baby estimated to be 4000gm or more may cause need for an episiotomy either to prevent laceration or in anticipation of a possible shoulder dystocia.
2. Preterm or small for gestational age baby
3. Fetal malpositions & malpresentations.
4. A thick perineum which is rigid &resistant to distention.
5. Prior to an assisted delivery such as forceps & vacuum extraction.
6. To speed up delivery if there is fetal distress.
Types of episiotomy:-
1. Medline or median episiotomy:-
The episiotomy incision is given in the midline, extending from the vaginal opening towards the anus.
The advantages are:
• Less blood loss with this procedure.
• Less pain.
• An easier to perform procedure.
• Wound repair is done easily.
• Better cosmetic results due to less scarring.
2. Mediolateral episiotomy:-
In a mediolateral episiotomy, the incision begins in the middle of the vaginal opening and extends down toward the buttocks at a 45-degree angle.
The primary advantage of a mediolateral episiotomy is that the risk for anal muscle tears is much lower. However, there is much more disadvantages associated with this type of episiotomy, including:
• increased blood loss
• more severe pain
• difficult repair
• higher risk of long-term discomfort, especially during sexual intercourse
Principles:-
The following principles should be observed regardless of which types of episiotomy is cut:-
1. The presenting part of fetus is protected from injury.
2. A single cut in any direction is far preferable to repeated snipping because the latter will leave jagged.
3. The episiotomy should be large enough to meet the purpose for deciding to cut it.
4. The timing should be such that lacerations are prevented & unnecessary blood loss avoided.
