Episiotomy

Question 1

What is the procedure up until insterting the needle?

Answer 1

Informed consent

Between contractions draw up the anaesthetic

Insert 2 fingers into the vagina behind the perineum protecting the presenting part

Johnson and Taylor (2016) Skills for Midwifery Practice. 4th ed. Churchill Livingstone

Question 2

What are the reasons for one?

Answer 2

Fetal distress

Failure to progress

Perceived imminent 3rd/4th degree tear

Instrumental delivery

Question 3

What is the procedure as the needle goes in?

Answer 3

Insert the full depth of the needle centrally at the introitus (fourchette), draw back, if not in a blood vessel inject 1/3 of the anaesthetic as the needle is withdrawn

Avoid taking the needle out of the tissue but reposition the needle, and reinsert in a mediolateral position

Instil the anaesthetic as described

Reposition the needle for a 3rd time in a fan shape in the perineum

Question 4

What is the procedure following the anaesthetic going in?

Answer 4

Allow 2 – 3 contractions for the anaesthetic to work

Reinsert 2 fingers protecting the presenting part again

Using scissors supplied make one decisive cut in a right mediolateral position, beginning at the fourchette, at an angle of 60 degrees from the midline, at the height of the contraction

Question 5

What is the procedure for delivery?

Answer 5

Immediately apply control to the fetal head, removing the scissors onto the trolley

Guard the perineum if able and slowly deliver the head

Continue with the delivery

Examine and suture episiotomy after delivery is complete

Question 6

Episiotomy procedure

Answer 6

A- infiltration of perineum

B- Incision ofepisiotomy

Question 7

Lidocaine

Answer 7

20mls for 0.5%

10mls for 1%