Labor and delivery - Episiotomy

Question 1

Indications for episiotomy

Answer 1

1. Expedite delivery in the 2nd stage of labor
2. When spontaneous laceration is likely
3. Maternal or fetal distress
4. Maternal exhaustion
5. Breech position
6. Assisted forceps
7. Large baby

Question 2

Muscles involved in a mediolateral episiotomy

Answer 2

1. Bulbospongiosus
2. Transversus perineus muscle

Question 3

Midline vs mediolateral

Surgical repair

Answer 3

• Midline
  
  • Easy
• Mediolateral
  
  • More difficult

Question 4

Midline vs mediolateral

Faulty healing

Answer 4

• Midline
  
  • Rare
• Mediolateral
  
  • More common

Question 5

Midline vs mediolateral

Postoperative pain

Answer 5

• Midline
  
  • Minimal
• Mediolateral
  
  • Common

Question 6

Midline vs mediolateral

Anatomical results

Answer 6

• Midline
  
  • Excellent
• Mediolateral
  
  • Occassionally faulty

Question 7

Midline vs mediolateral

Blood less

Answer 7

• Midline
  
  • Less
• Mediolateral
  
  • More

Question 8

Midline vs mediolateral

Dyspareunia

Answer 8

• Midline
  
  • Rare
• Mediolateral
  
  • Occassional

Question 9

Midline vs mediolateral

Extensions

Answer 9

• Midline
  
  • Common
• Mediolateral
  
  • Uncommon

Note: This is the only advantage of mediolateral

Question 10

Extent of first to fourth degree perineal lacerations

Answer 10

• First
  
  • Fourchette, skin, and vaginal mucous membrane
• Second
  
  • plus fascia and muscles of the perineal body
• Third
  
  • plus external anal sphincter
• Fourth
  
  • plus rectal mucosa