Episiotomy

Dr. Fekadu R(MD)

November, 2012/19
 Definition

• Is an incision into the perineal body made

during the second stage of labor to facilitate
delivery.

• It is by definition a second-degree tear.

7/18/21 Episiotomy 2
 Cont…

• The purported benefits of episiotomy include;

o Reduction in third and fourth degree tears

o Ease of repair and improved wound healing
o Preservation of the muscular and fascial support of the
pelvic floor
o Reduction in neonatal trauma, such as with the premature
infant (soft cranium) or macrosomic infant (shoulder
dystocia)
o Reduction in dystocia by increasing the diameter of the soft
tissue outlet
o Expedited delivery of fetuses with nonreassuring fetal heart
rate tracings

7/18/21 Episiotomy 3
 • Indications for Episiotomy
– macrosomia
– tight perineum
– breech delivery
– shoulder dystocia
– instrumental deliveries especially forceps
delivery
– destructive deliveries.

7/18/21 Episiotomy 4
 Cont…

• Episiotomy can be classified into two broad

categories: median and mediolateral.

• Median (midline) episiotomy

– refers to a vertical midline incision from the
posterior forchette toward the rectum, and is
preferred in the United States
– The size of the incision
• depends on the length of the perineum but is generally
approximately one half of the length of the perineum,
• should be extended vertically up the vaginal mucosa for a
distance of 2 to 3 cm.

7/18/21 Episiotomy 5
 Cont…

• Complications of median episiotomy include

– increased blood loss, especially if the incision is made too
early,
– fetal injury, and
– localized pain.

Mediolateral episiotomy
– the incision is made at a 45-degree angle from the
inferior portion of the hymeneal ring
– The length of the incision is less critical than with
median episiotomy, but longer incisions require
lengthier repair.

7/18/21 Episiotomy 6
 Midline & mediolateral episiotomies

7/18/21 Episiotomy 7
7/18/21 Episiotomy 8
 Comparison b/n Medial & Mediolateral Episiotomies

Medial Mediolateral

Technically easier to make and relatively

repair difficult
Healing better Less
Blood loss less more
Dysparunia less more
Anatomic end result Better less satisfactory

Extension into the relatively more rare

rectum common
risk of rectovaginal higher lower
fistula

7/18/21 Episiotomy 9
7/18/21 Episiotomy 10
 !
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D !!
EN
7/18/21 Episiotomy 11