EPISIOTOMY AND LACERATIONS

JUSTINE MANANGAN

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T I SS UE I N TE G R IT Y

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Tissue Integrity

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Skin and mucous membrane protection to support secretion, excretion and healing.

Having integrity means being whole, intact and undamaged.

Intact healthy skin protects all our other body organs and their functions.

Any break in the skin integrity makes the body susceptible to infection.

Factors Aecting Tissue Integrity and Wound Healing

Age

Genetics and heredity

Underweight or overweight

Decreased tissue perfusion

Decreased nutritional status

Medications that aect skin integrity

Wound care

Hydration

Hygiene

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Factors Aecting Tissue Integrity and Wound Healing
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1 OF 3

Chronic illness

Anemia

Type of Wound

Smoking

Infection

Substance abuse

Stress

Rest

Risks and Complication

Infection

Increased blood loss

Pain

Hematoma

Incontinence

Damage to rectal sphincter

Fistula formation

Formation of scar tissue

Sexual dysfunction

EPISIOTOMY AND LACERATIONS

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Episiotomy
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- A surgical incision made in the perineum and the posterior vaginal wall to expand the opening of the vagina during
childbirth

- Done prophylactically to prevent soft tissue damage

- One of the most common medical procedures

performed on women

- Routine use has steadily declined in recent decades

- Still widely practiced in many parts of the world

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Benefits
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JUSTINE MANANGAN

Prevention of lacerations

Easier to repair than laceration

Prevention of prolonged and overstretch of vagina

Minimizing compression and decompression of the fetal head

Shortening of second stage

Indications
- Risk of serious tearing

- Old perineal scar about to rupture

- Excessively rigid perineal muscles

- Large baby

- Preterm baby

- Prior to instrumental delivery

- Breech delivery

- Vulvoedema

- Fetal distress

- Shoulder dystocia

- Direct occiput posterior

- Case of female genital mutilation

Episiotomy Types
- Median or midline- a midline incision down to, but not, including the external anal sphincter

- Easier to perform and repair

- Results in less blood loss

- Causes less pain in the perineum

- Less dyspareunia later

- Better cosmetic appearance

- Inadvertent extension will injure external anal sphincter and rectum

Episiotomy Types
- Mediolateral- incision extending from the midline of the fourchette mediolaterally at 5 or 7 oclock towards the
direction of the ischial tuberosity

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- Less extension to anal sphincter

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- More dicult to perform and repair

- Results in more blood loss

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- More pain in perineum, more dyspareunia later

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- Poorer cosmetic appearance

2 OF 3
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EPISIOTOMY AND LACERATIONS

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Lacerations
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3 OF 3

First degree- involves only skin and superficial structures above muscle

Second degree- extends through perineal muscles

Third degree- extends through the anal sphincter muscle

Fourth degree- continues through anterior rectal wall

Labial

Vaginal

Cervical

Periuretheral

Clitoral

Nursing Care

Frequent assessment of perineum immediately after birth and then every 8 hours

Vital signs every 4 hours

Ice to relieve pain and decrease edema

Sitz baths and peri bottle

Analgesics

Frequent perineal care and peripad changes

Anesthetics sprays/ truck pads/ creams

Stool softeners

Encourage ambualtion

Reposition to relieve pressure to area

Maintain hydration

Encourage healthy diet

Encourage rest

Provide support and reassurance

Kegel exercises

Discharge teaching

JUSTINE MANANGAN