episiotomy mcq discussion

� EPISIOTOMY –
Meaning / Definition:-
-Episiotomy is a surgical incision of the perineum (area between vaginal opening and anus) made during the second stage of labour to enlarge the vaginal opening and facilitate childbirth.
Types of Episiotomy:-
� Midline (Median) Episiotomy
Incision: Straight down toward the anus
Advantages: Less pain, easier repair, less blood loss
Disadvantage: ↑ Risk of extension into anal sphincter
� Mediolateral Episiotomy (Most common in India �)
Incision: Diagonal, away from anus
Advantages: ↓ Risk of anal sphincter injury
Disadvantages: More pain & blood loss than midline
� Lateral Episiotomy
Incision: Lateral from vaginal opening
Status: Rarely used (↑ bleeding)
� J-Shaped Episiotomy
Incision: Curved away from anus
Status: Rarely practiced
Indications:-
� Rigid / non-stretchable perineum
� Instrumental delivery (forceps / vacuum)
� Fetal distress (need for rapid delivery)
� Shoulder dystocia
� Preterm baby (↓ head trauma)
� Large baby (macrosomia)
Anesthesia Used:-
� Local infiltration – 1% lignocaine (most common)
� Pudendal nerve block (if required)
� Spinal / Epidural (if already in place)
Suturing of Episiotomy (After Placental Delivery):-
Layer 1 – Vaginal mucosa
• Continuous locking sutures
Layer 2 – Perineal muscles
• Interrupted or continuous sutures
Layer 3 – Skin (Perineum)
• Subcuticular or interrupted sutures
Suture Material:
� Absorbable – Chromic catgut, Vicryl
Key Nursing Points:-
� Maintain strict aseptic technique
� Monitor for bleeding & hematoma
� Provide perineal care & pain relief
� Educate mother on hygiene & wound care
� Exam Pearl (AIIMS • NORCET • NCLEX)
� Mediolateral episiotomy is preferred because it reduces the risk of anal sphincter injury