An episiotomy, also known as perineotomy is a surgically planned incision on the perineum and the vaginal wall during childbirth.
It is the most common obstetric operation performed to prevent perineal injuries and tear during delivery.
Episiotomy is usually done to enlarge the vaginal opening so as to facilitate easy and safe delivery of the foetus; to minimize overstretching and rupture of the perineal muscles and to reduce the stress and strain on the fetal head during labour.
Indications of episiotomy
Episiotomy is recommended in selective cases rather than as a routine. If constant care is provided during childbirth, it can reduce the incidence of episiotomy and perineal injury. The reasons or indications of doing episiotomy are –
- Inelastic or rigid perineum in elderly primigravida causes arrest or delay in the descent of the presenting part.
- When there is a chance of perineal tear due to big baby, face to pubis delivery, breech delivery, shoulder dystocia, delivery in occipito-posterior position.
- In the case of operative delivery such as forceps delivery and ventouse delivery.
- Any previous perineal surgery like pelvic floor repair, perineal reconstructive surgery.
- It can be done in primigravida and multigravida due to risk of perineal injury.
Timing of the episiotomy
The ideal time is just prior to crowning when there is bulging thinned perineum during contraction occurs. If done early, the blood loss will be more. If done late, it fails to protect the pelvic floor and perineal muscles from tear. It should be done at right time by skilled personnel.
After the delivery of the baby, the episiotomy wound is repaired by absorbable sutures which need not be removed. It takes 15 to 20 days for the sutures to heal completely if there’s no infection.
Conclusion
In the above post, we discussed the timing and indications of episiotomy.
