Performing and repairing episiotomy
Clinical Learning Guide
STEP / TASK
Getting Ready
1.
Prepare the necessary equipment.
2.
Tell the woman (and her support person) what is going to be
done, listen to her and respond attentively to her questions and
concerns.
3.
Provide continual support and reassurance, as feasible.
4.
Ask about allergies to antiseptics and anesthetics.
5.
Put on personal protective barriers.
The Procedure
1.
Wash hands thoroughly with soap and water and dry with a clean,
dry cloth or air dry.
2.
Put high-level disinfected or sterile surgical gloves on both hands.
3.
Clean the perineum with antiseptic solution.
4.
Draw 10 ml of 0.5% Lignocaine into a syringe.
5.
Place two fingers into the vagina along the proposed incision line.
6.
Insert the needle beneath the skin for 4–5 cm following the same
line and aspirate by drawing the plunger back slightly to make certain
the needle is not penetrating a blood vessel.
7.
Inject the Lignocaine solution slowly while withdrawing the needle
towards a more superficial level to ensure an even distribution of the
anesthetic substance to all layers and over the whole length to the
anticipated cut (wound), this should include the vaginal mucosa, beneath
the skin of the perineum and into the perineal muscle.
STEP / TASK
8.
Wait 2 minutes and then pinch the incision site with forceps. (If
the woman feels the pinch, wait 2 more minutes and then retest).
1.
Wait to perform episiotomy until crowning where the head
distending the vulva and does not recede back in contractions and the
perineum is fully stretched over the head.
2.
Insert two fingers into the vagina, palmer side downward,
between the baby’s head and the perineum.
3.
Insert the open blade with the blunt tip of the episiotomy scissors
between the perineum and the two fingers.
4.
Make a single cut 3–4 cm long in a mediolateral direction (45º
angle to the midline toward a point midway between the ischial
tuberosity and the anus).
5.
If delivery of the head does not follow immediately, apply
pressure to the episiotomy site between contractions, using a piece of
gauze, to minimize bleeding.
6.
Control delivery of the head to avoid extension of the episiotomy.
Repair of episiotomy
1.
Ask the woman to position her buttocks toward the lower end of
the bed or table (use stirrups if available).
2.
Ask an assistant to direct a strong light onto the woman’s
perineum.
3.
Clean the woman’s perineum with antiseptic solution.
4.
If it is necessary to repeat local anesthetic, draw 10 ml of 0.5%
Lignocaine into a syringe.
5.
Insert the needle along one side of the vaginal incision and inject
STEP / TASK
the Lignocaine solution while slowly withdrawing the needle.
6.
Repeat on the other side of the vaginal incision and on each side
of the perineal incision.
7.
Wait 2 minutes to allow the Lignocaine solution to take effect.
8.
Using 2/0 chromic catgut, insert the suture needle just above (1
cm) the vaginal incision.
9.
Use a continuous suture from the apex downward to repair the
vaginal incision.
10.
Continue the suture to the level of the vaginal opening.
11.
At the opening of the vagina, bring together the cut edges.
12.
Bring the needle under the vaginal opening and out through the
incision and tie.
13.
Use interrupted inverted sutures to repair the perineal muscle,
working from the top of the perineal incision downward (in 2 layers if
deep incision).
14.
Use interrupted or subcuticular sutures to bring the skin edges
together.
15.
Clean with a disinfectant then place a clean pad on the woman’s
perineum.
Post Procedure
1.
Before removing gloves, dispose waste materials in a leak-proof
container or plastic bag.
2.
Place all instruments in 0.5% chlorine solution for 10 minutes for
decontamination.
3.
Decontaminate or dispose of syringe and needle:
STEP / TASK

If reusing needle or syringe, fill syringe (with needle
attached) with 0.5% chlorine solution and submerge in solution for 10
minutes for decontamination.

If disposing of needle and syringe, flush needle and syringe
with 0.5% chlorine solution three times, and then place in a sharps
container.
4.
Immerse both gloved hands in 0.5% chlorine solution. Remove
gloves by turning them inside out.

If disposing of gloves, place them in a leak-proof container
or a plastic bag.
5.
Wash hands thoroughly with soap and water and dry with a clean
dry cloth or air dry.
6.
Record the procedure in the record.