ROHILKHAND COLLEGE OF NURSING, BAREILLY

Procedure Checklist
Performing and suturing an Episiotomy

Check (√) Yes or No

S. No. Procedure steps 1 2 3 4 5
1. Place the patient on the delivery table in dorsal recumbent position when the fetal head is
distending the perineum.
2. Infilterate the perineum using 10 ml of local anesthetic. Wait for
3-5 minutes for the anesthetic to act.
3 Place your index and middle fingers in the vagina with palmar side down and facing you.
Separate them slightly and exert outward pressure on the perineal body.
4 Place the blades of the scissors in a straight up and down position, so that one blade is
against the posterior vaginal wall and the other blade is against the skin of the perineal
body with the point where the blades cross at the middle of the posterior fourchette.
5 Adjust the length of the blades of the scissors on the perineal body and predict the length
of the incision accordingly.
6 a. A mediolateral episiotomy is cut at a slant, starting at the midline of the fourchette
with the pouints of the scissors directed toward the ischial tuberosity on thye same side
as the incision.
b. A midline episiotomy is cut in the middle of the central tendinous points of the
perineum from the posterior fourchette down to the external anal sphincter.(The ideal
timing of episiotomy is a bulging thin perineum at the peak of a contraction just prior to
crowning).
7 If a midine episiotomy was cut,palpate for the external anal sphincter.
8 Cut again if needed,avoid snipping.Two cuts should accomplish the incision.
9 Extend the vaginal side of the incision if needed by incising the vaginal band. For this,
the scissors must come from above the backside of the hand to slide down the fingers and
make the cut .
10 Apply pressure with 4x4 sponges.
11 After completion of delivery assist for suturing of episiotomy incision.
12 Wipe the wound area with sterile antiseptic cotton swabs.
13 Focus light on the perineal area.
14 Diagnose the degree of perineal tear if any.
15 Pack the vagina with vaginal plug or tampon .
16 Visualize the apex of the mucosa ,start suturing little above the apex. Appose the vagina
tear by continuous suture using a round body needle.
17 Repair the perineal muscles by interrupted sutures, include the deeper tissue to enclose
dead space.
18 Perineal skin is apposed by mattress suture.
19 Remove the vaginal pack which was inserted during suturing.
20 Clean the perineum and apply perineal pads.
21 Straighten patients legs and assist her to supine position with legs crossed.
22 Wash and dry the instruments used for episiotomy along with those used for conduct of
delivery and suturing.
23 Record in the labor record ,the time episiotomy was performed ,type of
episitomy ,suturing carried out, and patients recation.
Total Score
Obtained Score
Percentage
Remark
Name of the student_____________________________ Date_________________ 

Course__________________________________ Class ________________

Name of Instructor/Evaluator: _______________________ Ward/Unit________________

Signature: __________________________

6- Highly Satisfactory – 85-100 Percentage

5 -Satisfactory – 69 – 84 Percentage
4 -Moderately Satisfactory- 52 to 68 Percentages
3 - Moderately Unsatisfactory- 35 to 51 Percentages
2 -Unsatisfactory – 18 to 34 Percentages
1 - Highly Unsatisfactory – 0-17 Percentage

Note:
1. 1, 2, 3, 4, 5 denoting attempt made by the students
2. Each statement will be score by Yes/No and yes contain 1 point & no contain zero point
3. Students who get 85 % or above will get full satisfactory and below will have to make attempt till the candidate
get 85% or above

Remarks by Evaluator:________________________________________________________

PRINCIPAL