Episiotomy and Perineal Repair Royal College of Obstetricians

Episiotomy and Perineal Repair © Royal College of Obstetricians and Gynaecologists

What to expect in this lecture 1. Regional anatomy 2. Identification and classification of perineal trauma 3. Sutures and repair technique 4. Postnatal care © Royal College of Obstetricians and Gynaecologists

Know your anatomy

Levator ani

Classification of perineal trauma • First degree: skin only • Second degree: involving perineal muscles • Third degree : involving anal sphincter complex • Fourth degree: involving anal sphincter complex and anal epithelium © Royal College of Obstetricians and Gynaecologists

Repair of perineal trauma • full inspection – PV and PR to classify the trauma – get help if not sure • identify the apex • three layers : vaginal mucosa: continuous non-locking absorbable suture, e. g. 2. 0 polyglactin perineal muscles: 2. 0 polyglactin skin: 2. 0 polyglactin

Show videos of basic principles for performing episiotomy Step 1 and step 2 © Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

Show video for undertaking the repair

Before finishing • check PR/PV at the end • check swabs, needles, instruments • beware sutures in rectum, buttonholes, missed apex • IV augmentin or similar

Postnatal care Explain to the woman: • the degree of trauma sustained • regular pain relief • advice on recovery and looking after the perineum (1 in 10 breakdown risk) • any follow up required including physio • additional relevant information e. g. mode of birth