Published on November 5, 2010
INTRODUCTION : Types of delivery •normal •operative Normal delivery-appropriate term, vertex ,normal weight of the fetus Operative-incision and instrumental such as foreceps, ventous Ceasarean-fetuses are delivered through the incision of the abdominal and uterine walls INTRODUCTION EPISIOTOMY : EPISION=PUBES,PUDENTA TOMY=CUTTING PERINEOTOMY OBJECTIVES AFTER COMPLETION OF THIS PRESENTATION A LEARNER IS ABLE TO •DESCRIBE THE TYPES OF DELIVERY •EXPLAIN COMPLETE PROCEDURE OF EPISIOTOMY •ANALISE MERITS AND DEMERITS OF EPISIOTOMY •EXPLAIN COMPLICATIONS •KNOW THE POST OPERATIVE CARE OF THE WOUND a EPISIOTOMY Slide 3: DEFINITION :- a surgically planned incision on the perineum during the second stage of labor. PURPOSES:- To enlarge the vaginalintroitus to facilitate easy and safe delivery of the fetus . To minimize over stretching and rupture of perineal muscles and fascia. To reduce the stress and strain on the fetal head. INDICATIONS : WHEN The baby is very large The fetal head is too large even in the vertex position Fetus is in breech Rigid perineum The operative delivery is recommended-forceps and ventous Baby’s shoulders r stuck (dystocia) INDICATIONS TYPES OF INCISIONS : Median Medio-lateral Lateral ‘J’ shaped Median:-starts from vaginal opening to anus(straight line) Medio-lateral:from center of the vagina either to the left or right towards the buttocks angles 45 degrees Lateral: incision starts from I cm away from the midpoint of vagina either left or right side ‘j’shaped:begins in the vagina and is directed posteriorly for about 1.5cm and then directed downwards and outwards like 5 or 7 ‘o’ clock TYPES OF INCISIONS Slide 7: Including 1 Pair disposable complete leg sleeves. 4 Sterile drapes. 6 Adhesive tapes 2x10cm to attach drapes and leg covers. 1 Stainless-steel needle-holder 7" (18cm.) long. 1 Europlas™ scissors sharp/blunt. 1 Eurofor™ insert forceps. 1 Europlas™ curved hemostat. 4 Gauze balls X-Ray detectable. 10 Gauze sponges 10x10cm X-Ray detectable. 1 Gynecological highly absorbent "mouse" tampon. 1 Medicine cup 30ml. 1 Syringe 20ml. 1 Needle 18G. 1 Needle 21G. Directions : Directions Direction for use of kit for Episiotomy procedure at childbirth Preparation: The following additional items are required: 1. 1 pr. surgical gloves of suitable size 2. antiseptic solution 3. sutures & suitable needles 4. anesthetics Direction for use: 1. Open the kit, remove the sterile field, & spread over the patient's abdomen or over any other working area with the polybacked surface facing downwards and the absorbent paper surface upwards. It is preferable to secure the sterile field with the elastic plasters to prevent slipping. Use of elastic plaster strips: Gently stretch the plaster lengthways, by using both hands, until the separation is visible at center cut - then easily remove the silicone paper. 2. Hold the tray on its under surface, & empty its contents onto the sterile field, taking care to prevent contact of the edge of the tray with the sterile field. Set the tray aside within easy reach, for use as a container for antiseptic solution during suturing. Slide 9: 3. Fit the disposable leg-sleeves onto the thighs of the patient, securing them with plasters. 4. Spread additional sterile field under the buttocks of the patient, with polybacking facing downwards, - absorbent surface in contact with the patient's body. 5. Additional sterile drape is for use as an apron or any other covering for the patient. 6. Remove the sutures aseptically from their first package, and place them on the sterile field together with the other kit components. 7. Pour antiseptic solution into the kit container. (The compartment is designed for economy) 8. Put on gloves and mask and commence the suturing procedure. Use the gauze & cotton tupfers, the "mouse" tampon, hemostats, syringe plus 2 needles, and medicine cup, as and when required in accordance with your experience in these procedures. 9. During and after the suturing procedure, all refuse must be disposed of in the suitable containers, including all the instruments - all instruments are for single, one time use only - for comfort and safety of patients, personnel and doctors PROCEDURE-STEPS : EXPLAIN THE COMPLETE PROCEDURE AND ADVANTEGES ↓ LET THE PATIENT LIE DOWN IN LITHOTOMY POSITION WITH GOOD LIGHT ↓ LOCAL ANAESTHESIA(10ml of 1% lignocaine) ↓ WASH THE PERINEUM ↓ PLACE 2 FINGERS BETWEEN THE VAGINAL WALL AND THE HEAD OF THE FETUS ↓ 2-3cm INCISION IS MADE ↓ DELIVER THE CHILD PROCEDURE-STEPS Slide 11: ↓ WIPE AND WASH AWAY THE BLOOD CLOTS ON THE PERINEUM ↓ SUTURING WITH POLY GLYCOLIC ACID SUTURE AND ‘O’ CHROMIC CATGUT POST OPERATIVE CARE : DRESSING:-EACH TIME FOLLOWING URINATION&DEFECATION(IS DONE BY SOAKING OF ANTISEPTIC SOLUTION FOLLOWED BY APPLICATION OF ANTISEPTIC POWDER OR OINTEMENT(FURACIN OR NEOSPORIN) COMFORT:-MAGNESIUM SULFATE COMPRESS OR INFRARED HEAT, ANALGESIC MAY BE USED . AMBULATION:-ALLOW THE PATIENT TO MOVE OUT OF BED AFTER 24 HRS. REMOVAL OF STITCHES:-IF THE WOUND IS SUTURED BY CATGUT OR DEXON IT WILL BE ABSORBED BUT SILK OR NYLON NON ABSORBABLE MATERIAL SHOULD BE REMOVED ON 6 TH DAY. POST OPERATIVE CARE COMPLICATIONS : INFECTION HEMORRHAGE PAIN PAIN WITH INTER COURSE. IRREGULAR BOWEL FUNCTION. COMPLICATIONS Slide 14: MERITS DEMERITS THE PERINIAL MUSCLES ARE NOT CUT. REPAIR IS EASY. HEALING IS FASTER. WOUND DISRUPTION IS RARE. INJURY TO THE RECTUM. BLOOD LOSS IS MORE. DYSPAREUNIA. INJURY TO THE BARTHOLIN’S DUCT. RESEARCH ABSTRACT : RESEARCH ABSTRACT Throughout the rest of the 20th Century, episiotomy was considered the standard of care by many American obstetric care providers. By 1979, episiotomy was performed in approximately 63% of all deliveries in the USA, with higher rates among nulliparas. In the UK in the same era, episiotomy rates ranged from 14 to 96% among nulliparas and 16–71% among multiparas.The purported short-term benefits for the parturient included its ease of repair compared with a spontaneous perineal laceration, improved postpartum pain and reduction in severe (third and fourth degree) lacerations. Additional long-term benefits were believed to accrue from decreasing the time that the perineum is stretched during birth, including prevention of pelvic floor relaxation, pelvic organ prolapse, sexual dysfunction, and urinary and fecal incontinence. The purported benefits to the neonate included prevention of asphyxia, cranial trauma, cerebral hemorrhage and mental retardation, as well as reduction in the incidence of shoulder dystocia. SUMMARY : SUMMARY Types of deliveries Objectives. Episiotomy definition and procedure. Post operative care. Complication. Merits and demerits. Research abstracts. EPISIOTOMY : BY N.GEETHA REDDY MS(N) EPISIOTOMY
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