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Episiotomy: definition

Episiotomy is used at the time of delivery to reduce the risk of perineal tear the mother facilitating the delivery of the baby. It involves cutting itself a part of the perineum (4-6 cm on average) to open the door to the baby's head when the tissues are too rigid. Currently, 65% of primiparous (women in their first pregnancy) are concerned with episiotomy, against 30% of multiparous women (women who have already completed one or more pregnancies).

How episiotomy?
Episiotomy is discussed by the medical team. It is practiced very end delivery just before the expulsion, at the time of uterine contraction or during expulsive effort, when the perineum is stretched to the maximum. The midwife or obstetrician is responsible for surgery. In the absence of epidural can local anesthesia or spinal anesthesia if necessary.

Perineal section is carried out either vertically or at an angle of 45 ° (mediolateral said section, the most widely practiced), by a movement starting from the vulva to anus. The muscular portion is cut, but the vaginal mucosa and the tissue of the vulva.

All fabrics are sewn immediately after delivery of the baby and placenta, usually using an absorbable suture.

Use of episiotomy
Long, episiotomy was performed in the hope of reducing the brutal and uncontrolled tearing of the perineum during childbirth. The phrase "explosive" of the fetal head was considered responsible for major incontinence (urinary and anal) and genital prolapse (prolapse). But clinical studies have not confirmed this hypothesis. Pregnancy itself is a decay factor of the perineum.

WHO recommends several years of not practicing episiotomy during childbirth hitherto normal, as in the following cases: signs of fetal distress, insufficient development work and threatening third-degree tear (severe).

This is why, in addition primiparity, the use of episiotomy is more frequent in cases of difficult childbirth: vaginal delivery by forceps, presentation breech baby, twins.

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