{"id":1754,"date":"2010-12-14T07:28:59","date_gmt":"2010-12-14T07:28:59","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/episiotomy\/"},"modified":"2023-09-20T10:01:13","modified_gmt":"2023-09-20T09:01:13","slug":"episiotomy","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/obstetrics\/management-of-childbirth\/episiotomy\/","title":{"rendered":"Episiotomy"},"content":{"rendered":"<hr \/>\n<h3><span style=\"text-decoration: underline;\"><span style=\"color: #003366;\"><strong>Introduction<\/strong><\/span><\/span><\/h3>\n<p><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Episiotomy<\/strong><\/span> is the incision into the <span style=\"color: #33cccc;\"><strong>perineum<\/strong><\/span> and the <span style=\"color: #33cccc;\"><strong>vagina<\/strong><\/span> (<em>using scissors or a scalpel<\/em>) to <span style=\"color: #33cccc;\"><strong>increase the size<\/strong><\/span> of the <span style=\"color: #33cccc;\"><strong>orifice<\/strong><\/span>.<\/span><\/p>\n<p><span style=\"color: #003366;\">Indications for performing an episiotomy are: <span style=\"color: #33cccc;\"><strong>avoiding tears<\/strong><\/span> of the vagina, perineum and anal sphincter, and <span style=\"color: #33cccc;\"><strong>shortening<\/strong><\/span> the delivery stage. There can be both maternal and foetal reasons for the latter. The majority of parturitions do not require an episiotomy.<\/span><\/p>\n<p><span style=\"color: #003366;\">The <span style=\"color: #33cccc;\"><strong>perineum<\/strong><\/span> can be incised in two ways. In the <span style=\"text-decoration: underline;\">mediolateral episiotomy<\/span>, the perineum and vagina are incised from the median posterior commissure at an angle of about 45\u00b0 dorsally, left or right of the anus. The technique for this type of episiotomy will be described later in greater detail. A median episiotomy proceeds in a median line from the posterior commissure to the anus. This gives rise to a wound with equal edges that is simpler to suture and causes fewer complaints in the confinement period than a mediolateral episiotomy. The chance of <span style=\"text-decoration: underline;\">rupturing<\/span> to the anal sphincter and the rectum is, however, relatively large. That is why the median episiotomy is not the treatment of choice in the Dutch obstetric tradition.<\/span><\/p>\n<hr \/>\n<h3><span style=\"text-decoration: underline;\"><span style=\"color: #003366;\"><strong>Preparation<\/strong><\/span><\/span><\/h3>\n<p><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Sufficient<\/strong> <strong>disinfection<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>good<\/strong> <strong>anaesthesia<\/strong> <\/span>are important. Bacteriological testing has revealed that more than 70% of episiotomy wounds are infected with microorganisms. This is hardly surprising considering the proximity of an important potential source of infection, the rectum. Yet an infection occurs in only 3% of all cases. Whether or not an infection develops depends on:<\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">The virulence of the microorganism.<\/span><\/li>\n<li><span style=\"color: #003366;\">The number of microorganisms.<\/span><\/li>\n<li><span style=\"color: #003366;\">The resistance of the immune system of the woman.<\/span><\/li>\n<\/ul>\n<p><span style=\"color: #003366;\">Nothing can be done to influence the virulence of the bacteria and the resistance of the immune system of the woman during parturition, but something can be done about the <span style=\"color: #33cccc;\"><strong>number of bacteria<\/strong><\/span>. If practitioners discover that more than 3% of episiotomies are infected in their practice, they should examine whether improvements need to be made regarding the disinfectants used, their disinfectant technique or the suturing.<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong>Material<\/strong> <em><strong>[Figure 36<\/strong><\/em>]:<\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">Episiotomy scissors or scalpel.<\/span><\/li>\n<li><span style=\"color: #003366;\">Infiltration anaesthetic.<\/span><\/li>\n<li><span style=\"color: #003366;\">Hypodermic syringe (10 ml).<\/span><\/li>\n<li><span style=\"color: #003366;\">Hypodermic needle (long).<\/span><\/li>\n<li><span style=\"color: #003366;\">Sterile drapes or ironed cotton clothes.<\/span><\/li>\n<li><span style=\"color: #003366;\">Povidone-iodine solution 10% or chlorhexidine 1%.<\/span><\/li>\n<li><span style=\"color: #003366;\">Gauze squares.<\/span><\/li>\n<li><span style=\"color: #003366;\">Gloves (sterile).<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1753\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-36.jpg\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-36.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-36-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 36<\/span><\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\">The best moment to perform the episiotomy depends on the indication. In order to prevent perineal scarring, in the case of a head presentation, the best moment is at the start of the contraction during which the child is to be born or, at most, two to three contractions before this.<\/span><\/p>\n<p><span style=\"color: #003366;\">Ensure <span style=\"color: #33cccc;\"><strong>sufficient analgesia<\/strong><\/span>. This can be provided by local infiltration with an anaesthetic or by pudendal nerve block as this nerve can be reached transvaginally or via the perineum. The latter technique is less simple and will not be discussed here. Infiltration anaesthesia with 10 to 20 ml (100-200 mg) lidocaine 1%, or prilocaine 1% without adrenalin, is the most usual form of analgesia. The time to effect is 3 to 5 minutes.<\/span><\/p>\n<p><span style=\"color: #003366;\">An episiotomy is usually performed with a special pair of scissors. A <span style=\"color: #33cccc;\"><strong>cleaner<\/strong><\/span> wound can be obtained with a scalpel. A pair of scissors bruises the tissue, a knife gives more vital wound edges that heal better, but it can prove difficult to carefully protect the presenting part of the foetus during incision. A combination is also possible. In this case, a scalpel should be used to incise the skin and subcutis and subsequently the scissors should be used to cut further into the vagina.<\/span><\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Introduction Episiotomy is the incision into the perineum and the vagina (using scissors or a scalpel) to increase the size of the orifice. Indications for performing an episiotomy are: avoiding tears of the vagina, perineum and anal sphincter, and shortening the delivery stage. There can be both maternal and foetal reasons for the latter. The [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[58],"tags":[138],"class_list":["post-1754","post","type-post","status-publish","format-standard","hentry","category-management-of-childbirth","tag-obstetrics"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Episiotomy - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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