Episiotomy and Perineal Care Flashcards
What is the definition of an episiotomy?
Episiotomy is defined as a surgical incision of the perineum made to increase the diameter of the vulval outlet during childbirth.
What are the pros and cons of restricted use of episiotomy?
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
What are the FOUR definite indications for an episiotomy?
- Fetal distress
- Prevent severe perineal trauma
- Femal genital mutilation
- Preventing severe perineal trauma during an instrumental delivery
What are the FOUR possible indications for an episiotomy?
- Aid delivery if perineum is “rigid”
- Reduce prolonged maternal pushing efforts in cases of severe hypertension
- Short perineum
- Pre-term delivery
What are the TWO types of episiotomy?
- Midline
- Mediolateral
Describe a midline episiotomy (FOUR points)
- 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
Describe a mediolateral episiotomy (THREE points)
- 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
Describe the SEVEN stages of the process for injecting local anaesthetic to the perineum
- 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- 1% lidocaine, 5-10mls is continually injected as the needle is withdrawn slowly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
Describe the THREE stages of the process for performing an episiotomy
- 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
List THREE immediate reactions to a wound
- Vasonconstriction clotting, platelets and endothelial cells, haemostasis/clot formation
- Inflammation - acute inflammatory response occurs within hours
- First line defence - leukocytes
List THREE reactions that take place during late inflammation following a wound
- 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
List FOUR reactions that take place during proliferation following a wound
- 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
List FOUR reactions that take place during maturation/remodelling following a wound
- 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
In relation to wound healing: what is meant by primary intention?
Wound edges are brought together by approximation
In relation to wound healing: what is meant by secondary intention?
Requires the formation of granulation tissue and wound contraction
