Where to cut the episiotomy

The process of childbirth for women is like walking through the gates of hell. This is very important for women. In fact, most women will choose natural childbirth when giving birth. As long as the umbilical cord is not entangled or the fetus is not in an abnormal position, natural childbirth is relatively safe. However, in the process of childbirth, because the baby is relatively large and the female vagina is relatively small, it will not be possible to give birth all of a sudden. At this time, episiotomy can be performed. Where exactly will the episiotomy go?

principle

The area between the labia and anus is the perineum. They are usually only 2-3cm long, but can be stretched to about 10cm long during production. This is because hormones stretch the perineum to assist in the birth of the baby. Stretching the perineum is relatively difficult during a first delivery. An episiotomy is an oblique incision made in the perineum. Episiotomy not only includes lateral incision, but also medial incision (for the convenience of description, it is collectively referred to as episiotomy below). It can prevent perineal tears in parturients, protect the pelvic floor muscles, and surgical incisions are easier to repair and heal better.

Indications

In primipara delivery with head presentation, the perineum is tight, long, the tissue is tough or underdeveloped, there is inflammation, edema, or the perineum fails to fully expand during emergency delivery. It is estimated that a degree II or above laceration will occur when the fetal head is delivered.

Head-pelvic disproportion caused by various reasons.

Multiparous women who have undergone episiotomy and suture, or who have large scars after repair that affect the expansion of the perineum.

Forceps-assisted delivery, vacuum extractor-assisted delivery, or vaginal delivery for first-time breech presentation.

Premature birth, intrauterine growth retardation or fetal distress require relief of fetal head pressure and early delivery.

Pregnant women who suffer from heart disease or high blood pressure and need to shorten the second stage of labor.

process

(I) Timing of incision

When the doctor sees the fetal head about to appear from the vaginal opening, he or she will immediately judge whether the baby is big and whether it will cause severe perineal tear, and then decide whether to perform an episiotomy. If the doctor judges that the delivery is going smoothly and the tear is not large even if the perineum is not cut, surgery can be avoided.

(II) Operation

The patient took the lithotomy position and used bilateral pudendal nerve block anesthesia. When the uterus contracted, the middle and index fingers of the left hand reached deep into the vagina to prop up the left vaginal wall. The perineum was cut open at a 45° angle to the left from the posterior perineum to the midline with episiotomy scissors. However, if the perineum is highly bulging, the cutting angle should be 60°~70° to avoid damaging the rectum. The incision is generally 4 to 5 cm. After the incision is made, gauze should be applied to compress and stop the bleeding. If necessary, clamps and ligatures should be used to stop the bleeding.

(III) Time

There is no need to spend time cutting slowly, but it can be cut quickly and instantly with medical scissors. The length of the cut is only about 2-5cm, and it really feels like "a moment". When the labor pains are severe, some women may not even realize that the incision has been made.

4. Pain level

Since the incision is made at the peak of labor pain, the episiotomy is basically not felt. In addition, due to the effect of local anesthesia, there is no need to worry about pain during incision.