EPISIOTOMY / PERINEAL TEAR
Definition: An incision made into the thinned –out perineal to enlarge the vaginal orifice during delivery of the infant.
Definition:The tissues between the anus and external genitals.
Indications for Episiotomy: To expedite delivery in the following circumstances.
v Pre-eclampsia (PIH)
v Eclampsia
v Cardiac or respiratory disease e.g. asthmatic patient.
v Previous Operation for pelvic floor repair
v Maternal distress
v Fetal distress
To prevent excessive trauma
1. Rigid perineum
2. Face to pubes delivery
3. Face delivery
4. Narrow pubic arch
5. Pervious 3rd degree tear
To prevent Cerebral damage
ü Slow advance of the head
ü Prematurity
ü After coming head of the breech
Types of Episiotomy
1. Medial
2. Medio-Lateral
3. Lateral
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Advantages of Episiotomy
1. Prevent over Stretching of pelvic floor muscles
2. Does not extend to involve the anus
3. Reduces maternal exhaustion and therefor lower the incidence of P.P.H
4. Reduces the risk of Cerebral damage to the infant.
5. Heals more readily than a ragged tear.
- Following Delivery: lacerations will heal more readily and tissues regain their tone more readily, if the following points observed.
1. Prompt Suturing of Lacerations – in the part of midwife.
2. Sitz Bath, Warm water with dettol.
3. Gentle and graduated post – natal exercise.
4. Early ambulation encouraged.
5. Attention paid to general health.
6. Prevention or treatment of anemia.
THE PERINAL BODY
Situation - It lies between the vaginal and rectal canals
Shape – It is triangular, the base being the skin and the apex pointing upwards.
Size - Each side of the triangle is approximately 3.8cm in length (1.5ms)
Structure – There are 3 layers of tissues
1. Outer covering of skin
2. Superficial pelvic floor muscles
a. Bulbo- Cavernosus
b. Transverseperinei
3. Deep pelvic floor muscle – pubo – coccygeus.
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Blood supply - Blood supply is from pudenda arteries branches of the internal iliac artery. Venous drainage is into the internal iliac vein.
Functions
The functions of the perineal body is to assist in the process of defecation and child birth.
Perineal Tear
A first degree Tear – This involves only the skin.
A Second Degree Tear- The skin and super facial muscles are involved, but a deep tear of this degree will also involve the deep muscles.
A Third Degree Tear -by far the most serious is the third degree tear. Not only skin and the perineal muscles are involved, but also the anal sphincter muscle.
Prevention of Tears - The expectant mother should be prepared for labour in the following ways.
Antenatal Period - (1) Attention to general health and prevention of anemia. A healthy body is more likely to its function in a satisfactory way.
2. Health Education- A basic knowledge of the process of labour should be taught, and the mother shown how she can co-operate during 1st& 2nd stages of Labour.
3. Antenatal exercise carried out daily will improve muscle tone.
During Labour- In the 1st Stage, the patient should not be allowed to “bear down” This cause overstretching of the muscle and also result in oedema of the cervix.
Management of Perineal Tear
1. Suturing of torn tissues must be carried out as soon as possible after delivery.
2. Perineal area must be kept clean and dry as possible.
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