Repair of episiotomy or perineal injury

Question 1

Repair of episiotomy or perineal injury
- features
- classifications

Answer 1

Features

• Examination of perineum made as soon as possible to asses degree of damage if any

Classification (of damage)

1. First degree tears
   a. No need of intervention
2. Seconds degree tears

a. Damage to posterior vaginal wall and perineal muscles (no anal sphincter damage)

b. Suturing required

3. Third degree tears

a. Second degree + anal sphincter damage

b. Analgesics and suturing required

4. Fourth degree tears

a. Third degree + anorectal mucosa damage

b. Analgesics and suturing required

Question 2

Repair of episiotomy or perineal injury

Complications

Answer 2

1. Anal incontinence
2. Perineal discomfort
3. Rectovaginal fistula

Question 3

ABC of episiotomy repair

Answer 3

1. Woman places in lithotomy position for good view of the wound
2. Use of analgesics
3. Identify apex of the incision or the
4. Use absorbable synthetic material with continuous suturing
5. On completion make sure:

a. Vagina is not constricted – 2 fingers should be inserted easily

b. No suture is in the rectum – to avoid fistula formation

6. In case of third- and fourth-degree damage

a. Prophylactic antibiotics
b. Surgical techniques used to repair are:

i. End to end method (A)
ii. Overlapping method (B)

c. Physiotherapy – pelvic floor exercises for 12 weeks

d. Bowel movements monitoring and stool softeners

e. Sexual dysfunction monitoring