Episiotomy: definition, types, indications, care, and complications

Dr. Sessa answers the most common questions pregnant women have about episiotomy.

What is episiotomy?

Episiotomy is a cut made in a controlled manner by the gynecologist or midwife in certain situations during the childbirth. Specifically, during the fetal expulsion period.

What is it about?

An episiotomy is an incision of variable length and direction over the vagina and perineum.

The objective of this incision will be to increase the usable space during fetal expulsion. This will It will facilitate the birth of the baby and avoid possible complications. derived from the excess pressure generated during said expulsion.

What structures are sectioned?

The sectioned structures are: skin, vaginal mucosa, subcutaneous cellular tissue and the bulbocavernosus and superficial transverse muscles of the perineum.

Are there different types of episiotomy?

If they exist 3 Types:

Side

It extends perpendicular to the vaginal midline.

Central or medial

It extends vertically from the vaginal introitus to the anus (in the midline).

Mediolateral

It extends from the vaginal introitus to either side. It forms an angle of approximately 45 degrees with the midline and can therefore be right or left.

It is important to know that lateral episiotomy is not a correct practice. Furthermore, there is sufficient evidence to avoid central episiotomy due to the increased risk of damage to the anal sphincter. Therefore, Mediolateral episiotomy will be the one of choice.

Should episiotomy be performed routinely?

NoIn fact, routine episiotomy has not been shown to reduce the rate of complications (vaginal tears, labor dystocia, etc.). What it will do is increase morbidity.

When is it indicated?

This should always be done individually. Likewise, it should be performed when the obstetrician or midwife observes a clear benefit from its implementation.

What do we achieve with a well-indicated and performed episiotomy?

With a well-indicated and performed episiotomy, we increase the effective space for the fetal head and body to emerge. In certain situations, this can:

prevent the appearance of vaginal tears,
facilitate and make safer the performance of an instrumental delivery
and reduce the expulsion time if circumstances so require.

What are the main complications?

La complication rate es low. Generally, proper indication of an episiotomy can prevent major complications. Thus, we'll differentiate between two groups of complications:

Early

Bleeding and tearing that extends beyond the episiotomy itself.

Late

Bruising, scar dehiscence, infections and chronic pain over the affected area.

How is the damaged area repaired after an episiotomy?

A suture will be performed in layers, starting with the muscle, continuing through the mucosa and ending at the skin. This repair is performed with absorbable sutures. Only the points placed in the perineal area will be visible (3 or 4 points are visible in most cases).

In this way, the aesthetic result will very satisfying in the vast majority of episiorrhaphies (suturing of an episiotomy).

What are the healing times for an episiotomy?

As a general rule, the area will be fully recovered in about two weeks.

Should special care be taken?

Yes, because it must be maintained. clean and dry wound, Avoiding any type of trauma or manipulation of the area. As we mentioned before, the stitches will, in the vast majority of cases, be absorbable, and they won't need to be removed.

Episiotomy: definition, types, indications, care, and complications