Overview

Episiotomy is a surgical incision made in the perineum during childbirth to enlarge the vaginal opening. It is performed to prevent severe perineal tears and facilitate delivery.

Episiotomy is crucial for preventing severe perineal tears, facilitating difficult deliveries, and reducing maternal morbidity. It should be performed judiciously based on clinical indications.

Learn more in our comprehensive RxDx OBG Course

Indications

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Shoulder Dystocia

Difficult shoulder delivery

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Forceps Delivery

Instrumental delivery

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Vacuum Delivery

Vacuum-assisted delivery

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Large Fetal Head

Macrosomia

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Rigid Perineum

Non-compliant perineum

Contraindications

Absolute Contraindications

✗ Patient refusal
✗ Active infection

Relative Contraindications

✗ Previous extensive perineal surgery
✗ Coagulopathy

📋 Equipment Checklist

Check off items as you gather them:

Pre-procedure Preparation

Preparation includes patient consent, local anesthesia, sterile technique, and proper positioning. All team members should understand their roles.

Step-by-Step Procedure

Step 1: Patient Preparation

Explain procedure, obtain consent, position patient.

⚠️ Common Mistakes to Avoid:

  • Inadequate consent
  • Poor positioning

💡 Pro Tip:

Ensure patient is comfortable and informed.

Step 2: Local Anesthesia

Infiltrate local anesthetic at incision site.

⚠️ Common Mistakes to Avoid:

  • Inadequate anesthesia
  • Wrong technique

💡 Pro Tip:

Use adequate local anesthetic for patient comfort.

Step 3: Incision

Make midline or mediolateral incision.

⚠️ Common Mistakes to Avoid:

  • Wrong incision type
  • Too deep incision

💡 Pro Tip:

Choose incision type based on clinical situation.

Step 4: Delivery

Complete delivery of baby and placenta.

⚠️ Common Mistakes to Avoid:

  • Rushed delivery
  • Incomplete delivery

💡 Pro Tip:

Complete delivery before repair.

Step 5: Repair

Repair episiotomy in layers.

⚠️ Common Mistakes to Avoid:

  • Incomplete repair
  • Poor approximation

💡 Pro Tip:

Repair in anatomical layers.

Step 6: Hemostasis

Ensure adequate hemostasis.

⚠️ Common Mistakes to Avoid:

  • Bleeding
  • Hematoma

💡 Pro Tip:

Check for bleeding before completion.

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Post-procedure Care

Post-procedure care involves perineal hygiene, pain management, wound monitoring, and patient education for recovery.

Complications & Management

Complication Incidence Signs Management Prevention
Bleeding 5-10% Excessive bleeding, hematoma Pressure, suturing Adequate hemostasis
Infection 3-8% Erythema, purulent discharge Antibiotics, drainage Sterile technique
Dehiscence 2-5% Wound separation Re-suturing Proper technique
Dyspareunia 10-20% Painful intercourse Pelvic floor therapy Gentle technique

Clinical Pearls

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Choose incision type based on clinical situation.

🎯

Use adequate local anesthetic for patient comfort.

⚡

Repair in anatomical layers.

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Check for bleeding before completion.

📊

Use sterile technique throughout.

🎨

Ensure proper perineal hygiene post-procedure.

⚠️

Monitor for complications post-procedure.