Episiotomy procedure

A surgically planned incision on the perineum and posterior wall during
the second stage of labour is called episiotomy.

Objectives :-
- To enlarge the vaginal introitus for safe delivery.
- To minimise overstretching of perineal muscles.
- To reduce the stress and strain on the fetal head.

Indication :-
- To in-elastic perineum.
- Big baby.
- Breech delivery.
- Shoulder dystocia.
- Face to pubis delivery.
- Operative delivery.
- Previous perineal surgery.

Timing :-
Just prior to crowning.

Advantages :-
- A clear controlled incision is easy to repair and heal.
- Reduction in the duration of second stage.
- Reduction of trauma to pelvic floor muscles.
- It minimise intracranial injuries of fetus.

Types :-
It has four types -
1. Medio-lateral episiotomy
2. Median episiotomy
3. Lateral episiotomy
4. 'J' shaped episiotomy
Mostly used episiotomy is medio-lateral.

Steps of medio-lateral episiotomy :-
Step 1 (preliminaries) :- Perineum is swabbed with antiseptic lotion.
Step 2 (incision) :-  The incision is made by a sharp scissors.
Step 3 (repair) :- The repair is done soon after expulsion of placenta.