Episiotomy and Perineal Care Flashcards Preview

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Flashcards in Episiotomy and Perineal Care Deck (18)
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1
Q

What is the definition of an episiotomy?

A

Episiotomy is defined as a surgical incision of the perineum made to increase the diameter of the vulval outlet during childbirth.

2
Q

What are the pros and cons of restricted use of episiotomy?

A

Pros:

  • Lower rates of posterior perineal trauma
  • Less suturing
  • Reduction in pain and healing complications

Cons:
-Associated with an increase in anterior vaginal wall trauma

3
Q

What are the FOUR definite indications for an episiotomy?

A
  • Fetal distress
  • Prevent severe perineal trauma
  • Femal genital mutilation
  • Preventing severe perineal trauma during an instrumental delivery
4
Q

What are the FOUR possible indications for an episiotomy?

A
  • Aid delivery if perineum is “rigid”
  • Reduce prolonged maternal pushing efforts in cases of severe hypertension
  • Short perineum
  • Pre-term delivery
5
Q

What are the TWO types of episiotomy?

A
  • Midline

- Mediolateral

6
Q

Describe a midline episiotomy (FOUR points)

A
  • Incision starts at the fourchette and is made vertically towards the anus
  • Easier to do and repair
  • Less perineal pain
  • Associated with a higher risk of 4th degree tears
7
Q

Describe a mediolateral episiotomy (THREE points)

A
  • Incision starts at the fourchette and is made diagonally to the left or right (between either 7-8 or 4-5 on a clock face)
  • More common in the UK
  • Thought to prevent 3rd and 4th degree tears
8
Q

Describe the SEVEN stages of the process for injecting local anaesthetic to the perineum

A
  • Explain procedure and gain consent
  • Place index finger and middle finger into the vagina between the presenting part and the perineum
  • Insert needle along the length of one side of the incision site
  • Draw back plunger of the syringe to check needle is not in a blood vessel (if blood appears then in vessel)
  • 1% lidocaine, 5-10mls is continually injected as the needle is withdrawn slowly
  • Do not fully withdraw the needle, but redirect to other site of incision site and repeat
  • Starts in 1 minute and lasts for approximately an hour
9
Q

Describe the THREE stages of the process for performing an episiotomy

A
  • Keeping fingers in place in the vagina following the anaesthetic injection, position the scissors between them in the direction of the incision
  • Perform the incision when the presenting part has distended the perineum, and do it in one single cut
  • Quickly place scissors down and rotate hand with fingers in the vagina, ready to “catch” the baby’s head to control delivery and prevent risk of further perineal trauma
10
Q

List THREE immediate reactions to a wound

A
  • Vasonconstriction clotting, platelets and endothelial cells, haemostasis/clot formation
  • Inflammation - acute inflammatory response occurs within hours
  • First line defence - leukocytes
11
Q

List THREE reactions that take place during late inflammation following a wound

A
  • Neutrophils ingest foreign material
  • Second line defence - monocytes (macrophages are the ones in the tissues) not only clean tissues but also produce growth factors for new capillary growth
  • Normal inflammation characteristics - redness, possibly some swelling, a slight local increase in temperature and some pain
12
Q

List FOUR reactions that take place during proliferation following a wound

A
  • New blood vessels form around the wound
  • Fibroblasts (cells that produce collagen) are attracted by macrophages
  • Fibroblasts proliferate from 2-4 days and produce a matrix
  • Proliferation and epithelialisation restore the epithelial barrier of the skin
13
Q

List FOUR reactions that take place during maturation/remodelling following a wound

A
  • Initial fibrin clot is replaced by granulation tissue
  • Density of macrophages and fibroblasts decrease - growth of capillaries, blood flow and metabolic activity decreases
  • Remodelling phase lasts up to or beyond a year
  • Density of fibroblasts decrease and mature in to a scar
14
Q

In relation to wound healing: what is meant by primary intention?

A

Wound edges are brought together by approximation

15
Q

In relation to wound healing: what is meant by secondary intention?

A

Requires the formation of granulation tissue and wound contraction

16
Q

In relation to wound healing: what is meant by third intention?

A

Contaminated wound left open and packed to allow good inflammatory response and growth of new cells at the wound edges

17
Q

List EIGHT possible signs of infection

A
  • Increasing erythema
  • Swelling
  • Change in colour
  • Odour of exudate
  • Increased white cell count
  • Increasing pain and tenderness
  • Pyrexia
  • Tachycardia
18
Q

What drug (and what dose) can be administered per rectum to help ease perineal pain?

A

Diclofenac 100mgs